The utility of bleeding on probing and 0.25% sodium hypochlorite rinse in the treatment of periodontal disease

Background.;Objective clinical indices used to differentiate between healthy sites and those with active periodontal disease are of great importance to the clinician. Due to the dichotomous nature of the clinical response, indices involving the determination of the presence or absence of bleeding have been regarded as an unbiased type of clinical assessment. It is important to understand the relationship of bleeding on probing (BOP) to other traditional measurements of the severity of periodontal disease. The purpose of the present study was to determine if there is a correlation between BOP and plaque score, pocket depth, or subgingival microbiota present in study participants with periodontitis.;Materials and Methods Thirty otherwise healthy adults, diagnosed with periodontitis, were included in the study. The following clinical variables were evaluated at baseline (Visit 1), two weeks post-baseline (Visit 2) and 3 months post-baseline (Visit 3): medical history, dental radiographs, number of teeth, presence or absence of plaque, presence or absence of bleeding on probing, pocket depth, gingival recession, mobility and furcation involvement. Participants randomly received professional subgingival irrigation with either sodium hypochlorite 0.25% (test) or water (control) at visit 1 and visit 2 and rinsed at home twice- a-week with either sodium hypochlorite 0.25% (test) or water (control) throughout the course of the study. The presence of plaque and BOP were recorded as dichotomous variables. Pocket depth was recorded as a discrete variable in mm and was further dichotomized into >4 and ≤4 mm. Descriptive statistics were calculated at each visit. Pearson chi-squared and correlation coefficient tests were used to assess the relationship between BOP and plaque score as well as BOP and pocket depth. The significance level was set at alpha =0.05. Additionally, the patients were grouped into two separate cohorts according to presence or absence of BOP in the sites that were sampled, and the microbiota present at these sites were analyzed within each group. The difference within the groups between the data at baseline, Visit 2 and whenever available, Visit 3, were compared using Wilcoxon signed-rank sum test. Comparisons between test and control group at each of the 3 time points were accomplished using Wilcoxon Mann-Whitney's U test. A two-sided alternative hypothesis and a 0.05 significance level were assumed in all testing. Data analysis was performed using SAS v9.3 and STATA (c) statistical software (StataCorp, College Station, Texas, USA).;Results The results indicate that there was a statistically significant correlation between BOP and plaque score within each group (test, control and pooled) at all study times (p<0.0001). There was a statistically significant correlation between BOP and pocket depth within each group at all study times (p<0.0001). Pocket depth and the incidence of BOP were positively correlated. A statistically significant correlation was found between BOP and the pocket depths >4 mm within each group at all study times (p<0.0001). Due to the small number of BOP positive sites that were sampled, no statistically significant differences were found in the microbiota between Visit 1 and Visit 2 or between test and control groups (p>0.05).;Conclusions The present study showed a high statistical correlation between the presence of BOP and the plaque score. Moreover, a statistically significant positive correlation was observed between pocket depth and BOP; i.e. as pocket depths increased, the incidence of BOP also increased. Within the limitations of this study, it can be concluded that BOP is a clinical measurement that is strongly correlated to other key indicators of periodontal disease. Further studies are warranted to explore the complex relationship between BOP and periodontal disease progression.