Message Boards
Today's Active Topics Browse Forum Categories My Recent Activity My Messages Private Groups My Marked Threads My Subscriptions
Today's Active Images Today's Active Polls Most Active Topics Global Townie Map Advanced Message Board Search Message Board Terms of Use

Perio Reports

Perio Reports  Vol. 17 No. 2
Perio Reports provides easy to read research summaries on topics of specific interest to clinicians.

Perio Reports research summaries will be included each month to keep you on the cutting edge of dental hygiene science.
Antimicrobial Agents
* Dr. Slots presents his views on antimicrobial agents

Periodontal disease is a bacterial infection, with pockets harboring 500 bacterial species. The most common treatment for periodontal infections is subgingival debridement, including scaling and root planing which is time consuming, technically difficult and considered unpleasant by patients. Instrumentation is done blindly except where the Perioscope® is available and can leave behind calculus and bacterial biofilm on up to 30% of the total surface area treated.

Systemic antibiotics are available, but better reserved for the aggressive infections and then used only after microbiological analysis to ensure the appropriate drug is selected. The use of systemic antibiotics for chronic periodontal disease is not clearly supported by research.

Controlled release devices are available containing one of a variety of antibiotics: tetracycline-HCL, doxycycline, minocycline, metronidazole or ofloxacin. Not all of these products are currently available in the USA. The case can be made favoring a broad spectrum antiseptic over an antibiotic based on the potential for development of resistant strains, adverse reactions, and for sites harboring yeasts to respond adversely to an antibiotic. Research to support these suggestions is not available. The financial cost to patients is a documented concern.

The antiseptic agents discussed in this paper include: Povidone-iodine, sodium hypochlorite (household bleach), and chlorhexidine. Antiseptics have a broader spectrum of activity than antibiotics and multiple intracellular targets, which reduces the potential for resistance to develop. Because antiseptics are toxic to both human cells and infectious agents, application is limited to infected wounds, skin and mucousa.

Povidone-iodine
Iodine has been used for skin infections, burns and wounds for 150 years. Povidone-iodine was introduced in the 1960s for control of a wide variety of bacterial, fungal, and viral infections. Despite its impressive abilities, Povidone-iodine is not widely used for the treatment and prevention of oral infections. Dr. Slots suggests using a 10% solution as a subgingival irrigant either before or after subgingival instrumentation, with repeated applications to reach five minutes of exposure for all pocket areas. It can also be used as the irrigant with power scalers, diluting it one part Povidone-iodine to nine parts water. Large, multi-center studies are lacking in this area, probably because the commercial potential of 20 cents worth of Povidone-iodine per patient is not enough to off set the high cost of long-term, multi-center studies, at least not for commercial funding sources. The article does include a listing of 17 research studies evaluating the effectiveness of Povidone-iodine for control of oral infections. Povidone-iodine is contraindicated for people with iodine sensitivity, hyperthyroidism, or women who are pregnant or nursing.

Sodium Hypochlorite
Household bleach has been used as a disinfectant for 100 years, an antiseptic for 85 years, and an endo irrigant for 75 years. Antiformin is concentrated bleach and has been used for curettage of pocket epithelium. Very dilute bleach is suggested for subgingival irrigation: one teaspoon to 8 oz of water. An endodontic laboratory study found 2.25% sodium hypochlorite, and 10% Povidone-iodine, followed by a 0.2% chlorhexidine solution effective against a biofilm. Clinical studies are now needed to evaluate this three-part approach. Limited research is published demonstrating the effectiveness of a 0.5% and a 0.1% bleach solutions for enhanced healing outcomes following periodontal treatment.

Clinical Implications: Dr. Slots suggests that when mechanical therapy alone is not enough, a five minute subgingival irrigation with 10% Povidone-iodine should follow instrumentation and at home the patient should irrigate with a 0.1% bleach solution, use a chlorhexidine rinse and an anti-carious fluoride rinse. More clinical research is needed to support these simple, economical suggestions.

Slots, J.: Selection of Antimicrobial Agents in Periodontal Therapy. J of Perio Research 37: 389-398, 2002.
Combination Therapy
* Combination therapy provides synergistic effects

The ideal treatment for periodontal infections has yet to be determined. Three approaches include instrumentation, antibiotics and plaque removal. Periodontal debridement therapy, also called scaling and root planing (SRP), is the most common treatment for periodontal disease. Systemic antibiotics are recognized as a valuable adjunct in the treatment of periodontal infections. Frequent dental hygiene visits for removal of plaque following definitive treatment have also been shown to enhance healing. These three aspects of treatment have been the subject of numerous research studies either alone or in combination.

Researchers in Brazil treated 44 adult patients to compare various combinations of instrumentation, systemic metronidazole and weekly plaque removal visits. The three-month study compared four groups: 1) SRP and a placebo pill (control group), 2) SRP plus metronidazole, 3) SRP, placebo pill and weekly plaque removal visits, and 4) SRP, metronidazole and weekly plaque removal visits. The antibiotic dosage of 400 mg three times a day for ten days was based on the Physicians Desk Reference (PDR) recommendations for treatment of an anerobic infection.

At the end of three months, the control group and the three treatment groups all showed improved clinical health. Plaque levels, bleeding scores, pocket depths and suppuration were all reduced from baseline levels. Group 4, the combination of all three treatments, showed slightly more healing in deeper pockets compared to the other groups. The two groups that received weekly plaque removal showed the greatest improvement, especially in pockets 6 mm or less. Results for the two groups that did not receive weekly plaque removal were also similar. These findings are interesting, considering the antibiotic and placebo were represented in both subgroups, suggesting that the addition of a systemic antibiotic following SRP may not provide as much benefit as the addition of weekly dental hygiene visits.

Clinical Implications: The addition of weekly supragingival plaque removal visits may enhance healing following debridement therapy. The addition of a systemic antibiotic was most effective only when combined with weekly plaque removal visits.

Carvalho, L., D’Avilla, G., Leão, A., Haffajee, A., Socransky, S., Feres, M.: Scaling and Root Planing, Systemic Metronidazole and Professional Plaque Removal in the Treatment of Chronic Periodontitis in a Brazilian Population I. Clinical Results. J Clin Perio 31: 1070-1076, 2004.
Tooth Loss Predictions
* Teeth surrounded by inflamed tissue are at risk

The true outcome measure of an effective oral hygiene program is the number of teeth retained over many years. Plaque and bleeding are surrogate outcomes that relate to the true outcome variable of tooth loss. Studies must extend over the lifetime of individuals to actually evaluate influences on tooth loss.

Researchers in Switzerland evaluated the data from a 26-year study conducted in Norway between 1969 and 1995. Five examinations were conduced between those years. The study began with 487 young males between the ages of 16 and 34. Of the 487 subjects, only 75 or 15% of the group lost teeth over the course of the study. These men all received regular dental care and reported brushing their teeth at least once a day.

During the 26 years, 126 teeth were lost, accounting for less than 1% of all the teeth. Tooth loss during this study was evaluated and correlated with gingival bleeding. From baseline data as well as data over the years, it was possible to group teeth based on the consistent level of oral health in the tissue surrounding each individual tooth. Teeth surrounded by consistently healthy tissue were assigned to Group I. This group accounted for a very small fraction of the tooth loss, only 0.28%.

Those with redness but very little bleeding were assigned to Group II. This group accounted for 2.28% of the tooth loss. Those with consistent bleeding upon probing were put into Group III. This group accounted for the greatest percentage of lost teeth, 11.2%. Based on these long-term findings, gingival inflammation can increase the risk of tooth loss by 46 times.

Clinical Implications: Continue to work toward optimum oral health as measured by lack of bleeding upon probing. These findings support the goal of bleeding scores of zero.

Schätzle, M., Löe, H., Lang, N., Bürgin, Ånerud, A., Boysen, H.: The Clinical Course of Chronic Periodontitis. J. Clin Perio 31: 1122-1127, 2004.
Oraqix® Gel Anesthetic
* Topical gel anesthetic well received

Three studies have already been completed showing Oraqix topical gel provides adequate anesthesia for periodontal instrumentation. The anesthesia may not be as profound as achieved with an injection, but the elimination of the needle injection and the short duration of numbness seem to outweigh the less profound anesthesia.

This study evaluated patients’ preference for either the new subgingival gel or an injection and their willingness to pay for the new subgingival gel. This study was conducted at eight periodontal clinics in Belgium; four clinics were in dental schools and four in private practice. A total of 157 subjects completed all phases of the study, including two clinic visits for a quadrant of instrumentation using Oraqix in one quadrant and injections in the other, plus written questionnaires at each visit and a phone call interview following each visit to check for adverse reactions. Instrumentation included both hand and ultrasonics. Repeat anesthesia was provided if requested for both the gel and injections.

The questionnaires asked about patients’ comfort during the procedures and preference for injections or the gel. They were also asked their willingness to pay for the gel.

The gel was preferred by 70%, the injections by 22% and 8% had no preference. Those preferring the gel based that decision on the reduced numbness following treatment. Those preferring injections said less pain was their reason. Satisfaction with anesthesia achieved with injections was reported by 96% compared to 80% satisfactory anesthesia for the gel. When asked if they thought the clinician could adequately perform the treatment, 100% were satisfied with the injection and 76% were satisfied with the gel. There were 44% who were somewhat to extremely bothered by the sensations after the gel, compared to 63% after injections. When asked if they were willing to pay for the topical anesthetic gel, 60% said yes, and 40% said no.

Clinical Implications: Although the Oraqix provided less profound anesthesia, patients preferred it to injections. This new topical anesthetic provides an alternative for pain control during subgingival instrumentation.

Funding: This study was partially funded by AstraZeneca – original developers of Oraqix.

Van Steenberghe, D., Garmyn, P., Geers, L., Hendrickx, E., Maréchal, M., Huizar, K., Kristofferson, A., Meyer-Rosenberg, K., Vandenhoven, G.: Patients’ Experience of Pain and Discomfort During Instrumentation in the Diagnosis and Non-Surgical Treatment of Periodontitis. J Perio 75: 1465-1470, 2004.
Sponsors
Site Menu
Message Boards Articles Continuing Education Podcasts Blogs Classifieds News Events Townie® Poll Ebooks Townie Choice Awards
Company Info
Contact Us Advertise With Us Howard Farran DDS, MBA Policies and Agreements
Site Help
Sally Gross, Member Services Specialist
Phone: +1-480-445-9710
Email: sally@farranmedia.com
©2025 Hygienetown, a division of Farran Media • All Rights Reserved
9633 S. 48th Street Suite 200 • Phoenix, AZ 85044 • Phone:+1-480-598-0001 • Fax:+1-480-598-3450