New treatment strategies for periodontitis

In order to reduce the chance for an intra-oral transmission (also called cross-contamination) of pathogens during periodontal therapy, a new treatment strategy called "one-stage, full-mouth disinfection" has been introduced. This strategy attempts to eradicate, or at least suppress, periodontopathogens in a short time span, and this not only from the periodontal pockets but also from all their intra-oral habitats (mucous membranes, tongue, and saliva). Several comparative studies between the one-stage, full-mouth approach and the standard therapy (root planing per quadrant with 2 week intervals), clearly illustrated the benefits of such a full-mouth approach in relation to gain in attachment, pocket depth reduction, microbiological shifts (for review see Quirynen et al. (2001)). Besides pathogens the periodontal pocket also harbours a number of so called beneficial species. These species could be applied after periodontal therapy to replace the pathogens. Such an approach, called replacement therapy, seems to be very helpful in other fields of medicine. Early observations with a replacement therapy in the treatment of periodontitis, both in vitro as well as in the animal, are very promising. My presentation will give a general overview on the scientific background of the intra-oral bacterial transmission, as well as of most recent clinical observations with the full-mouth strategies, including additional improvements of the concept. The early observations with the replacement therapy will also be discussed.