Background Information:

What are the other Names for the Procedure?

• Full-Mouth Disinfection
• Mouth Disinfection

What is Full Mouth Disinfection?

• Full Mouth Disinfection is part of the treatment undertaken for gum disease (chronic periodontitis), when the gums and bones are affected in adults
• In addition to scaling and cleaning of affected soft tissue, gum, and root surfaces, an antiseptic agent (such as chlorhexidine) is used to disinfect the region

What part of the Body does the Procedure involve?

A Full Mouth Disinfection procedure involves the teeth, gums, and jaw bones.

Why is the Full Mouth Disinfection Performed?

A Full Mouth Disinfection procedure is performed for the following reasons:

• It is used to eliminate bacteria due to gum disease
• Help avoid re-infection in treated gum regions and prevent worsening of gum disease
• The treatment can also help avoid loss of affected teeth

What are some Alternative Choices for the Procedure?

A Full Mouth Disinfection is undertaken as part of advanced gum disease treatment. There are no suitable alternative choices for the procedure.

What are the Recent Advances in the Procedure?

There are no recent advances in the area of Full Mouth Disinfection procedure.

What is the Cost of performing the Full Mouth Disinfection?

The cost of Full Mouth Disinfection procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Full Mouth Disinfection procedure and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

https://www.propdental.es/en/periodontal-disease/full-mouth-disinfection/ (accessed on 01/03/2018)

Prior to Full Mouth Disinfection:

How is the Full Mouth Disinfection Performed?

A Full Mouth Disinfection procedure is a non-invasive technique that forms a part of chronic periodontal therapy (or gum disease treatment).

• Under local anesthesia, the affected region is numbed
• Plaque and tartar deposits are removed using dental instruments
• An antibacterial oral rinse is used to flush the region. The irrigation of the gums is undertaken 2-3 times

A Full Mouth Disinfection procedure is typically done through 1 to 2 sessions of 1 to 1.5 hours each, (usually within 24 hours of each other). After the disinfection procedure, the following steps may be undertaken by the dental professional:

• The dentist cleans and polishes the teeth over 3-4 short sessions
• After about 3 months, a follow-up is necessary to check how gum disease is healing (or has healed). If necessary, any buildup of plaque is removed again

Where is the Procedure Performed?

Full Mouth Disinfection procedure may be performed in an out-patient surgery center facility, a dentist or an oral surgeon’s clinic or office, or a hospital.

Who Performs the Procedure?

A dental professional performs the Full Mouth Disinfection procedure.

How long will the Procedure take?

A Full Mouth Disinfection procedure takes about 60-90 minutes per session, and there may be 2 sessions planned, typically within 24 hours of each other.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Full Mouth Disinfection procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Full Mouth Disinfection procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Full Mouth Disinfection?

Before a Full Mouth Disinfection procedure, the patient has to undergo certain tests that may be necessary for gum disease such as:

• Routine blood and urine analysis
• X-ray of the mouth

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Full Mouth Disinfection procedure?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests or periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Full Mouth Disinfection:

What kind of Anesthesia is given, during the Procedure?

Local anesthesia by injection is administered during scaling and cleaning the affected gums/teeth.

How much Blood will you lose, during the Procedure?

Generally, there is no blood loss involved during a Full Mouth Disinfection procedure. However, some bleeding may take place while cleaning the gums/teeth and removal of plaque or tartar.

What are the possible Risks and Complications during the Full Mouth Disinfection?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
• Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders and chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during Full Mouth Disinfection process include:

• Excessive bleeding from gum disease
• Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Full Mouth Disinfection?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.

After the Full Mouth Disinfection:

What are the possible Risks and Complications after Surgery?

The possible risks and complications that may arise after the Full Mouth Disinfection procedure include:

• Excessive bleeding
• Re-infection in the affected site
• Worsening of gum disease (chronic periodontitis)

What is the Prognosis after the Surgery?

• The prognosis after a Full Mouth Disinfection is usually good with optimal outcomes. However, the overall prognosis depends upon the severity of the underlying gum disease
• In mild cases of gum disease, the prognosis is better and recovery time is shorter; compared to individuals with severe gum disease, wherein the recovery may take weeks to months.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain that worsens and swelling around the gums and teeth
• Bleeding or fluid drainage from the affected site
• The occurrence of any symptom that causes uneasiness such as nausea or vomiting
• Signs of an infection
• Headache, muscle aches
• Fever, feeling sick
• Dizziness
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Full Mouth Disinfection?

At home, the following post-operative care is recommended after a Full-Mouth Disinfection procedure:

• Avoid smoking and fizzy drinks for the first few day after the procedure
• If any pain or facial swelling is noted, then apply ice packs to relieve pain after the procedure
• Take painkiller medication, if necessary, as advised by the dental professional
• Complete the course of prescribed medication under advice of the physician
• Avoid drinking alcoholic beverages
• Follow-up with good oral hygiene and care

How long does it normally take to fully recover, from the Procedure?

The overall recovery time depends on the underlying gum disease and its successful treatment.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

• Generally, the procedure does not involve the surgical removal of any tissue
• In case of any tissue removal, majority of the times, it is not sent for examination. But if the dental professional determines it should be, then it is sent

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Usually, no tissue is sent for a pathological analysis. However, if a tissue sample is sent, then:

• The tissue removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Full Mouth Disinfection?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• An out-patient surgery center facility, the dentist or oral surgeon’s clinic/office, or a hospital
• An anesthesiologist (if anesthesia was administered)
• A pathologist (if the tissue is sent for analysis)
• A dental healthcare professional

The patient is advised to inquire and confirm the type of billing, before the Full-Mouth Disinfection procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA