Periodontitis
Conditions
Brief summary
Periodontitis is a form of gum disease that affects many people in the world. Its traditional protocol of treatment includes oral hygiene instruction and dental scaling to remove debris, dental plaque and tartar in 4 weekly sections. There is an additional time-reduced option also usually cheaper. In this last one, all above described procedures are performed within 24 hours. However, up to now comparative effectiveness between these both types of treatment is not well understood. For, example it is not clear if patients treated in the shorter-time experienced more pain. Therefore, the present study used several parameters to clarify whether beneficial differences between these therapeutic protocols exist or not. In addition, aspects that could help clinicians' and patient's decisions such as experience of pain and anxiety related to dental treatment were also investigated. After receiving verbal and written explanations and signed the informed consent form 150 individuals (n=15/group) having the most common type of periodontitis in adults were randomly allocated to be treated in 4 weekly sections or within 24 hours. Oral hygiene instructions and dental debridement were performed alone or in conjunction with antimicrobial agents: a mouth rinse containing chlorhexidine or systemic azithromycin antibiotic tablets. The parameters measured at baseline, 3, 6 and 9 months after treatment were: indicators of inflammation, amount of oral debris and malodor; quantification of bacteria in plaque samples collected with paper points from teeth and tongue; amount of produced saliva and self-reported questionnaires to collect information about oral condition, daily activities, pain and anxiety related to dental treatment.
Interventions
PROCEDUREFMS full-mouth scaling
Participants received oral hygiene instructions and full-mouth scaling within 24 hours. Debridement procedures were carried out under local anesthesia with manual Gracey and McCall curettes and Hirschfield files.
PROCEDUREQS quadrant scaling
Participants received oral hygiene instructions and quadrant scaling in 4 weekly sections. Debridement procedures were carried out under local anesthesia with manual Gracey and McCall curettes and Hirschfield files.
DRUGFMS chlorhexidine rinse
Participants received oral hygiene instructions and full-mouth scaling within 24 hours followed by a 60-day use of 0.12% chlorhexidine mouth rinse (15mL/30 seconds/ 2 times a day). Debridement procedures were carried out under local anesthesia with manual Gracey and McCall curettes and Hirschfield files.
DRUGFMS placebo rinse
Participants received oral hygiene instructions and full-mouth scaling within 24 hours followed by a 60-day use of placebo mouth rinse (15mL/30 seconds/ 2 times a day). Debridement procedures were carried out under local anesthesia with manual Gracey and McCall curettes and Hirschfield files.
DRUGFMS azithromycin tablets
Participants received oral hygiene instructions and full-mouth scaling within 24 hours followed by a 3-day use of azithromycin tablets (1 tablet/day). Debridement procedures were carried out Debridement procedures were carried out under local anesthesia with manual Gracey and McCall curettes and Hirschfield files.
DRUGFMS placebo tablets
Participants received oral hygiene instructions and full-mouth scaling within 24 hours followed by a 3-day use of placebo tablets (1 tablet/day). Debridement procedures were carried out under local anesthesia with manual Gracey and McCall curettes and Hirschfield files.
DRUGQS azithromycin tablets
Participants received oral hygiene instructions and full-mouth scaling in 4 weekly sections followed by a 3-day use of azithromycin tablets (1 tablet/day). Debridement procedures were carried out Debridement procedures were carried out under local anesthesia with manual Gracey and McCall curettes and Hirschfield files.
DRUGQS placebo tablets
Participants received oral hygiene instructions and full-mouth scaling in 4 weekly sections followed by a 3-day use of placebo tablets (1 tablet/day). Debridement procedures were carried out Debridement procedures were carried out under local anesthesia with manual Gracey and McCall curettes and Hirschfield files.
DRUGQS chlorhexidine rinse
Participants received oral hygiene instructions and full-mouth scaling in 4 weekly sections followed by a 60-day use of 0.12% chlorhexidine mouth rinse (15mL/30 seconds/2 times a day). Debridement procedures were carried out Debridement procedures were carried out under local anesthesia with manual Gracey and McCall curettes and Hirschfield files.
DRUGQS placebo rinse
Participants received oral hygiene instructions and full-mouth scaling in 4 weekly sections followed by a 60-day use of 0.12% placebo mouth rinse (15mL/30 seconds/2 times a day). Debridement procedures were carried out Debridement procedures were carried out under local anesthesia with manual Gracey and McCall curettes and Hirschfield files.
Sponsors
Fundação de Amparo à Pesquisa do Estado de São Paulo
University of Taubate
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* mild to moderate chronic periodontitis; * at least 20 natural teeth; * good general health
Exclusion criteria
* systemic diseases or other conditions that could influence the periodontal status; * events of high blood pressure or diagnosed hypertension; * alcohol abuse; * orthodontic devices; * extended prosthetic fixed devices, removable partial dentures or overhanging restorations; * pregnancy or breast-feeding; * history of sensitivity or suspected allergies following the use of oral hygiene products and/or the test antibiotic; * the need for antibiotic prophylaxis; * antibiotics and/or anti-inflammatory drug use in the three months prior to the beginning of the study; * regular use of chemotherapeutic antiplaque/antigingivitis products; * any furcation lesions; * periodontal treatment performed within six months prior to study initiation; * unwillingness to return for follow-up.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Improvements in pocket depth and clinical attachment level measurements | Changes in pocket depth and clinical attachment level measurements from baseline to 6 months | Primary outcomes of effectiveness were improvements of the following clinical parameters: periodontal pocket depth (mm) and clinical attachment level (mm) from baseline to 6 months. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Improvements in plaque index and gingival index | Changes from baseline to 3 months | Improvements in plaque index (scores) and gingival index (scores) when baseline data was compared to 3 months data. |
| Maintenance of pocket depth and clinical attachment level measurements | Changes in pocket depth and clinical attachment level from 6 months to 9 months | Pocket depth (mm) and clinical attachment level (mm) values observed at 6 were compared to those observed at 9 months. |
| Changes in total bacterial load and levels of selected pathogens | 3 months | Reductions in total bacterial load and levels of selected pathogens were determined by real time PCR (polymerase chain reaction) in samples from periodontal pockets and dorsal tongue. Values between baseline and 3 months were compared. |
| Changes in volume of gingival crevicular fluid and levels of pro-inflammatory cytokines | 3 months | Possible reductions in gingival crevicular fluid volume and in concentrations of tumor necrosis factor alfa (TNFα) and interleukin 1 beta (IL-1β) were measured by comparing values between baseline and 3 months. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Impact of periodontal treatment on quality of life | 6 and 9 months | The expected positive effect of periodontal treatment on quality of life (score) was measured by comparing baseline data and data collected at 6 and 9 months after therapy |
| Improvements in organoleptic and volatile sulphur compounds measurements | 3 months | The expected positive impact of periodontal treatment on organoleptic (score) and volatile sulphur compounds (mean values) measurements were evaluated at 3 months. |
| Impact of periodontal disease on quality of life | Baseline | The expected negative effect of periodontal disease on quality of life (score) was measured by analyzing baseline data. |
| Dental Anxiety experience | Baseline | Dental Anxiety (score) was measured immediately before treatment. |
| Experience of pain | at the second day for full-mouth scaling groups; or at month for quadrant scaling groups. | Experience of pain (scale) due to type of scaling was evaluated immediately after treatment. |
| Changes in nitrite levels | 6 months | Changes in nitrite levels (mean values) in saliva was determined by comparing baseline and 6 months values. |
Countries
Brazil
Outcome results
None listed