SCALING TODAY HOW TO IMPROVE THE CLINICAL STATUS ?

Although periodontitis has a multi-factorial aetiology (including susceptibility increasing factors), the success of its therapy mainly focuses on the eradication/reduction of the exogenous/endogenous periodontopathogens, respectively. Subgingival debridement still is the golden standard in the treatment of periodontitis. Based on the few studies that followed the dynamics of the subgingival re-colonisation after mechanical debridement, one should however realise that several days after therapy, the number of subgingival bacteria will nearly reach its initial level (reductions around 0.5 log value).
Most periodontopathogens colonise several niches within the oral cavity (e.g. the mucosae, the tongue, the saliva, the periodontal pockets and all intra-oral hard surfaces such as teeth, dentures, oral implants) and even the sinus and tonsils. Since these species can be transmitted between these niches (= intra-oral translocation), periodontologists should consider the oro-pharyngeal area as a microbiological entity, instead of treating periodontitis by a sequence of local acts. Since especially untreated pockets jeopardise the healing of recently instrumented sites, the treatment of periodontitis should involve an “one-stage” approach of all pathologic pockets (one-stage full-mouth disinfection) or should at least consider the use of antiseptics during the intervals between consecutive instrumentations, in order to prevent a microbial translocation of periodontopathogens during the healing period.
For the same reason, regeneration procedures or the local application of antibiotics should be postponed until a maximal improvement has been obtained in the remaining periodontium. This more global approach offers significant additional clinical and microbiological benefits.