FMT—“Full Mouth Therapy”
Non-surgical Therapy, plus …
FMD—“Full Mouth Disinfection”
“Full Mouth Disinfection”—FMD
It is becoming more and more clear that purely mechanical, non-surgical periodontitis therapy can be greatly improved if all of the currently available pharmacologic possibilities are utilized. Such possibilities improve the success rates for pocket reduction and clinical attachment gain to the levels achieved by surgical methods (Drisko 2002; Quirynen et al. 2002).
The therapeutic terms antimicrobial and anti-infectious do not imply only that the root surfaces in the area of pockets are scraped clean; rather, that the microbial colonizers of the pocket must be reduced, and those microbes with pathogenic potential must be eliminated. This principle also holds true for the entire oral cavity with all of its plaque retentive niches, and the recolonization of residual pockets; the oral cavity must therefore also be thoroughly disinfected (FMD). And finally, the oral cavity of the patient’s partner must be examined and treated as necessary.
The principal procedure for “full mouth therapy” including “full mouth disinfection” is portrayed in the figure below (Fig. 646).
Practical Procedure for FMT
The procedure is simple and includes the following steps (Quirynen et al. 2001; Saxer 2001):
An extended hygiene phase; goal: PI and BOP ≤ 15%
Actual closed pocket therapy—FMT, pharmacomechanical, within a short period of time
Supervised follow-up care (mouth, tongue, teeth)
During the hygiene phase the patient is motivated in toothbrushing technique, tongue cleansing with a brush or scraper, and the periodontal pockets are purely mechanically debrided, deeper and deeper at each appointment.
After achieving the established hygiene goals, the actual “full mouth therapy,” now pharmacomechanical, is instituted within a 24-hour period of time (p. 210):
Oral rinses (CHX 0.1–0.2%) 1–2 days before initiating therapy (reduction of the “bacterial load” in the oral cavity)
Mechanical pocket therapy, including: Use of antiseptics during the FMT; repeated pocket rinsing (CHX 0.2%; H2O23% plus betadine 0.5%), and “filling” the pocket with CHX gel after treatment
Supervised follow-up care (tongue cleansing with CHX).
FMT—Instrumental/Mechanical and …
Is “full mouth therapy” the wonder concept of the future? Here remains the controversy! Where praise is heard, criticism is not far behind. The loudest outcry against FMT: The “brutal” hours-long stress situation for the patients during the 24-hour treatment, and the occasionally occurring bout of fever following therapy!
It has long been known that fever, even septic shock, may be the reaction after massive antibiotic administration and the subsequent massive death of bacteria; this also leads to an equally large release of bacterial metabolic by-products, e.g., LPS (also PGE2, IL-1, IL-6 etc.). The host response may be overcome.
The proper use of FMT prevents this type of stress and fever: During the extended hygiene phase, the bacterial mass in the oral cavity and within pockets is reduced successively from appointment to appointment using careful mechanical instrumentation and without local anesthesia. Thus, at the end of the hygiene phase, most shallow pockets are already “healed” and only a few deep and active pockets remain to be treated by the FMT method.