La translocation intra buccale des bactéries parodontopathogènes compromet le devenir du traitement parodontal. Une revue critique de la littérature

Abstract Background: Although periodontitis has a multi‐factorial aetiology, the success of its therapy mainly focuses on the eradication/reduction of the exogenous/endogenous periodontopathogens. Most of the species colonise several niches within the oral cavity (e.g. the mucosae, the tongue, the saliva, the periodontal pockets and all intra‐oral hard surfaces) and even in the oro‐pharyngeal area (e.g., the sinus and the tonsils). Methods: This review article discusses the intra‐oral transmission of periodontopathogens between these niches and analyses clinical studies that support the idea and importance of such an intra‐oral translocation. Results and conclusions: Based on the literature, the oro‐pharyngeal area should indeed be considered as a microbiological entity. Because untreated pockets jeopardise the healing of recently instrumented sites, the treatment of periodontitis should involve “a one stage approach” of all pathologic pockets (1‐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 dentition. This more global approach offers significant additional clinical and microbiological benefits.