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Involvement of Tunisian General Practitioners in the Management of Patients at Risk of Infective Endocarditis: A Cross-Sectional Study. Int J Dent 2021; 2021:5542534. [PMID: 33833802 PMCID: PMC8016554 DOI: 10.1155/2021/5542534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/19/2021] [Accepted: 03/04/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives This work aimed to estimate the knowledge and practice of general dentists in the governorate of Manouba regarding the management of patients at risk of infective endocarditis. Materials and Methods A survey involving private sector general dentists in the governorate of Manouba was performed. It contained 21 questions, and it was addressed to 111 dentists. Only 82 dentists responded. To carry out the descriptive study, we used the SPSS software version 21.0. Results Our results proved the lack of knowledge among dentists in the governorate of Manouba with regard to the management of patients at risk of infective endocarditis. An overestimation of the risk and an overprescription of antibiotic were found in order to ensure an over-protection for the patients as well as the dentist. In fact, 85.4% of these dentists prescribed antibiotic prophylaxis for the two groups of patients (high risk and moderate risk). Only 9.8% followed the right modality of antibiotic prophylaxis prescription; 4.9% of the dentists prescribed antibiotic only 1 hour before the act and 4.9% of them prescribed antibiotic 1 hour before the act and continued the treatment in case of the presence of an infectious site. Conclusion A discrepancy towards an over-estimation of risk and overprescription of antibiotic was found between the recommendations and real practice. Similar studies in the other governorates of Tunisia are recommended in order to better understand the problem.
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Abstract
Wound healing is a fundamental survival mechanism, largely taken for granted. It consists of four intricately tuned phases: haemostasis, inflammation, proliferation and remodelling. Successful wound healing only occurs if each phase occurs in the correct sequence and timeframe. Moreover, the oral cavity serves as a unique and remarkable setting whereby wound healing takes place in a saliva-filled environment containing millions of micro-organisms. Many local and systemic factors can impair oral wound healing. This article provides an overview of the wound healing process, with a discussion of these respective local and systemic factors, along with the potential cellular and/or molecular mechanisms involved. CPD/Clinical Relevance: On a daily basis, dentists perform procedures such as exodontia and implant placement that rely on adequate wound healing. An improved understanding of the local and systemic factors that can impair oral wound healing can help clinicians to control these factors more accurately, resulting in improved patient outcomes.
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Affiliation(s)
- Raunaq Shah
- MSc Advanced Prosthodontics (Distinction) (UCLan), Department of Implantology, College of Medicine and Dentistry, 32–34 Colmore Circus, Queensway, Birmingham, B4 6BN
| | - Farya Domah
- Department of Oral Surgery, Birmingham Dental Hospital, 5 Mill Pool Way, Birmingham, B5 7EG
| | - Nirmal Shah
- Department of Orthodontics, Edinburgh Dental Institute, Lauriston Place, Edinburgh, EH3 9HA
| | - Javed Domah
- School of Medicine, University of Dublin, Trinity College, College Green, Dublin 2, Ireland
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3
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Arteagoitia I, Rodriguez Andrés C, Ramos E. Does chlorhexidine reduce bacteremia following tooth extraction? A systematic review and meta-analysis. PLoS One 2018; 13:e0195592. [PMID: 29684028 PMCID: PMC5912716 DOI: 10.1371/journal.pone.0195592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 03/25/2018] [Indexed: 11/29/2022] Open
Abstract
Background and aims Scientific evidence is not clear regarding the use of antimicrobial mouth rinse before dental extraction to reduce bacteremia. We tested the null hypothesis that there would be no difference in the incidence of bacteremia following dental extractions in patients treated with or without chlorhexidine. Material and methods We conducted a meta-analysis following the recommendations proposed by PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The data sources Pubmed, Cochrane, Web of Science, Science Direct, Scopus, and Ovid MD were searched until April 30, 2017. (chlorhexidine) AND (bacteremia OR bacteraemia) AND (extraction OR removal) were used as key words in a free-text search. Published meeting abstracts were searched. The references of each article were reviewed. We only included randomized controlled clinical trials. There were no restrictions regarding language or date of publication. The outcome measure was the incidence of the bacteremia measured within the first ten minutes post-extraction. Two reviewers independently undertook the risk of bias assessment and data extraction. A fixed-effects inverse variance weighted meta-analysis was conducted. Results Out of 18 studies, eight eligible trials with 523 participants were selected, 267 in the experimental group and 256 in the control group: risk ratio = 0.882 (95% confidence interval 0.799 to 0.975; p = 0.014), heterogeneity I2 = 13.07%, and p = 0.33. The number needed to treat was 16 (95% CI 7-Infinity). Conclusions Approximately 12% of bacteremia cases can be prevented if a population is exposed to chlorhexidine. CRD42016046586.
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Affiliation(s)
- Iciar Arteagoitia
- Department of Stomatology I, University of the Basque Country (UPV/EHU) Bizkaia, Spain
- BioCruces Health Research Institute, Bizkaia, Spain
- * E-mail: ,
| | - Carlos Rodriguez Andrés
- Department of Epidemiology and Public Health, University of the Basque Country (UPV/EHU) Bizkaia, Spain
| | - Eva Ramos
- BioCruces Health Research Institute, Bizkaia, Spain
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Reis LC, Rôças IN, Siqueira JF, de Uzeda M, Lacerda VS, Domingues R, Miranda KR, Saraiva RM. Bacteremia after supragingival scaling and dental extraction: Culture and molecular analyses. Oral Dis 2018; 24:657-663. [PMID: 28994220 DOI: 10.1111/odi.12792] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 09/06/2017] [Accepted: 09/29/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To study the incidence and magnitude of bacteremia after dental extraction and supragingival scaling. SUBJECTS AND METHODS Blood samples were taken before and 5 and 30 min after dental extraction and supragingival scaling from individuals at high (n = 44) or negligible risk (n = 51) for infective endocarditis. The former received prophylactic antibiotic therapy. Samples were subjected to aerobic and anaerobic culture and quantitative real-time polymerase chain reaction to determine the incidence of bacteremia and total bacterial levels. RESULTS Patients who did not receive prophylactic antibiotic therapy had a higher incidence of positive blood cultures (30% 5 min after extraction) than patients who received prophylactic antibiotic therapy (0% 5 min after extraction; p < .01). Molecular analysis did not reveal significant differences in the incidence or magnitude of bacteremia between the two patient groups either 5 or 30 min after each of the procedures evaluated. Extraction was associated with higher incidence of bacteremia than supragingival scaling by blood culture (p = .03) and molecular analysis (p = .05). CONCLUSIONS Molecular methods revealed that dental extraction and supragingival scaling were associated with similar incidence of bacteremia in groups receiving or not prophylactic antibiotic therapy. However, blood culture revealed that antibiotic therapy reduced viable cultivable bacteria in the bloodstream in the extraction group.
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Affiliation(s)
- L C Reis
- National Institute of Cardiology, Rio de Janeiro, Brazil
| | - I N Rôças
- Department of Endodontics, Estácio de Sá University, Rio de Janeiro, Brazil
| | - J F Siqueira
- Department of Endodontics, Estácio de Sá University, Rio de Janeiro, Brazil
| | - M de Uzeda
- Department of Endodontics, Estácio de Sá University, Rio de Janeiro, Brazil
| | - V S Lacerda
- National Institute of Cardiology, Rio de Janeiro, Brazil
| | - Rmcp Domingues
- Institute of Microbiology Paulo de Góes, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - K R Miranda
- Institute of Microbiology Paulo de Góes, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - R M Saraiva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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5
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Rademacher WMH, Walenkamp GHIM, Moojen DJF, Hendriks JGE, Goedendorp TA, Rozema FR. Antibiotic prophylaxis is not indicated prior to dental procedures for prevention of periprosthetic joint infections. Acta Orthop 2017; 88. [PMID: 28639846 PMCID: PMC5560223 DOI: 10.1080/17453674.2017.1340041] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and purpose - To minimize the risk of hematogenous periprosthetic joint infection (HPJI), international and Dutch guidelines recommended antibiotic prophylaxis prior to dental procedures. Unclear definitions and contradictory recommendations in these guidelines have led to unnecessary antibiotic prescriptions. To formulate new guidelines, a joint committee of the Dutch Orthopaedic and Dental Societies conducted a systematic literature review to answer the following question: can antibiotic prophylaxis be recommended for patients (with joint prostheses) undergoing dental procedures in order to prevent dental HPJI? Methods - The Medline, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs), reviews, and observational studies up to July 2015. Studies were included if they involved patients with joint implants undergoing dental procedures, and either considered HPJI as an outcome measure or described a correlation between HPJI and prophylactic antibiotics. A guideline was formulated using the GRADE method and AGREE II guidelines. Results - 9 studies were included in this systematic review. All were rated "very low quality of evidence". Additional literature was therefore consulted to address clinical questions that provide further insight into pathophysiology and risk factors. The 9 studies did not provide evidence that use of antibiotic prophylaxis reduces the incidence of dental HPJI, and the additional literature supported the conclusion that antibiotic prophylaxis should be discouraged in dental procedures. Interpretation - Prophylactic antibiotics in order to prevent dental HPJI should not be prescribed to patients with a normal or an impaired immune system function. Patients are recommended to maintain good oral hygiene and visit the dentist regularly.
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Affiliation(s)
- Willem M H Rademacher
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam (ACTA);,Correspondence:
| | - Geert H I M Walenkamp
- Department of Orthopedic Surgery and Research Institute CAPHRI, Maastricht University Medical Centre, Maastricht
| | | | - Johannes G E Hendriks
- Department of Orthopaedics Greater Eindhoven, Máxima Medical Centre and Catharina Hospital, Eindhoven
| | | | - Frederik R Rozema
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam (ACTA)
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Souza AF, Rocha AL, Castro WH, Gelape CL, Nunes MCP, Oliveira SR, Travassos DV, Silva TA. Dental management for patients undergoing heart valve surgery. J Card Surg 2017; 32:627-632. [DOI: 10.1111/jocs.13211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Alessandra F. Souza
- Faculty of Dentistry; Department of Community and Preventive Dentistry; Universidade Federal de Minas Gerais; Minas Gerais Brazil
| | - Amanda L. Rocha
- Faculty of Dentistry; Department of Oral Surgery and Pathology; Universidade Federal de Minas Gerais; Minas Gerais Brazil
| | - Wagner H. Castro
- Faculty of Dentistry; Department of Oral Surgery and Pathology; Universidade Federal de Minas Gerais; Minas Gerais Brazil
| | - Claudio L. Gelape
- Faculty of Medicine; Department of Surgery; Universidade Federal de Minas Gerais; Minas Gerais Brazil
| | - Maria Carmo P. Nunes
- Faculty of Medicine; Department of Surgery; Universidade Federal de Minas Gerais; Minas Gerais Brazil
| | - Sicilia R. Oliveira
- Faculty of Dentistry; Department of Oral Surgery and Pathology; Universidade Federal de Minas Gerais; Minas Gerais Brazil
| | - Denise V. Travassos
- Faculty of Dentistry; Department of Community and Preventive Dentistry; Universidade Federal de Minas Gerais; Minas Gerais Brazil
| | - Tarcília A. Silva
- Faculty of Dentistry; Department of Oral Surgery and Pathology; Universidade Federal de Minas Gerais; Minas Gerais Brazil
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Millot S, Lesclous P, Colombier ML, Radoi L, Messeca C, Ballanger M, Charrier JL, Tramba P, Simon S, Berrebi A, Doguet F, Lansac E, Tribouilloy C, Habib G, Duval X, Iung B. Position paper for the evaluation and management of oral status in patients with valvular disease: Groupe de Travail Valvulopathies de la Société Française de Cardiologie, Société Française de Chirurgie Orale, Société Française de Parodontologie et d'Implantologie Orale, Société Française d'Endodontie et Société de Pathologie Infectieuse de Langue Française. Arch Cardiovasc Dis 2017. [PMID: 28629781 DOI: 10.1016/j.acvd.2017.01.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Oral health is of particular importance in patients with heart valve diseases because of the risk of infective endocarditis. Recommendations for antibiotic prophylaxis before dental procedures have been restricted, but the modalities of oral evaluation and dental care are not detailed in guidelines. Therefore, a multidisciplinary working group reviewed the literature to propose detailed approaches for the evaluation and management of buccodental status in patients with valvular disease. Simple questions asked by a non-dental specialist may draw attention to buccodental diseases. Besides clinical examination, recent imaging techniques are highly sensitive for the detection of inflammatory bone destruction directly related to oral or dental infection foci. The management of buccodental disease before cardiac valvular surgery should be adapted to the timing of the intervention. Simple therapeutic principles can be applied even before urgent intervention. Restorative dentistry and endodontic and periodontal therapy can be performed before elective valvular intervention and during the follow-up of patients at high risk of endocarditis. The detection and treatment of buccodental foci of infection should follow specific rules in patients who present with acute endocarditis. Implant placement is no longer contraindicated in patients at intermediate risk of endocarditis, and can also be performed in selected high-risk patients. The decision for implant placement should follow an analysis of general and local factors increasing the risk of implant failure. The surgical and prosthetic procedures should be performed in optimal safety conditions. It is therefore now possible to safely decrease the number of contraindicated dental procedures in patients at risk of endocarditis.
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Affiliation(s)
- Sarah Millot
- Department of oral surgery, Montpellier university hospital, 34295 Montpellier, France; Inserm 1149, 75018 Paris, France
| | - Philippe Lesclous
- Department of oral surgery, Nantes hospital, university of Nantes, Inserm U791, LIOAD, 44093 Nantes, France
| | - Marie-Laure Colombier
- Department of periodontology, Louis-Mourier hospital, AP-HP, university of Paris Descartes, 92700 Colombes, France
| | - Loredana Radoi
- Department of oral surgery, Louis-Mourier hospital, AP-HP, university of Paris Descartes, Inserm U1018, 92700 Colombes, France
| | - Clément Messeca
- Odontology department, Bichat hospital, AP-HP, 75018 Paris, France
| | - Mathieu Ballanger
- Department of oral surgery, Pitié-Salpétrière hospital, AP-HP, university of Paris Descartes, 75013 Paris, France
| | - Jean-Luc Charrier
- Department of oral surgery, Bretonneau hospital, AP-HP, university of Paris Descartes, 75018 Paris, France
| | - Philippe Tramba
- Department of implantology and prosthetics, Pitié Salpétrière hospital, AP-HP, university of Paris Descartes, 75013 Paris, France
| | - Stéphane Simon
- Endodontics department, Pitié-Salpétrière hospital, AP-HP, Paris-Diderot university, 75013 Paris, France
| | - Alain Berrebi
- Department of cardiology, Georges Pompidou european hospital, AP-HP, institut mutualiste Montsouris, 75014 Paris, France
| | - Fabien Doguet
- Department of thoracic and cardiovascular surgery, Rouen university hospital, Inserm U1096, 76000 Rouen, France
| | - Emmanuel Lansac
- Department of cardiac surgery, institut mutualiste Montsouris, 75014 Paris, France
| | - Christophe Tribouilloy
- Department of cardiology, university hospital of Amiens, Inserm U1088, Jules-Verne university of Picardie, 80480 Amiens, France
| | - Gilbert Habib
- Department of cardiology, La Timone hospital, Aix-Marseille university, 13385 Marseille, France
| | - Xavier Duval
- Centre of clinical investigations, Inserm 1425, Bichat hospital, AP-HP, Paris-Diderot university, Inserm U1137, AEPEI, 75018 Paris, France
| | - Bernard Iung
- Department of cardiology, Bichat hospital, AP-HP, DHU FIRE, Paris-Diderot university, 46, rue Henri-Huchard, 75018 Paris, France.
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de Souza AF, Rocha AL, Castro WH, Ferreira FM, Gelape CL, Travassos DV, da Silva TA. Dental care before cardiac valve surgery: Is it important to prevent infective endocarditis? IJC HEART & VASCULATURE 2016; 12:57-62. [PMID: 28616544 PMCID: PMC5454162 DOI: 10.1016/j.ijcha.2016.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 05/27/2016] [Accepted: 07/03/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Infective endocarditis (IE) is a serious disease that affects the surface of the endocardium. The spread of microorganisms from the oral cavity has been associated with the occurrence of IE. OBJECTIVE To analyze whether dental treatment before cardiac valve surgery (CVS) influenced the occurrence of IE. METHODS We performed a retrospective analysis of the medical and dental histories of patients undergoing CVS from 2004 to 2014. The sample consisted of 481 patients who underwent CVS divided into two groups: patients submitted to dental treatment prior to CVS (n = 110) and patients undergoing CVS without dental treatment (n = 371). RESULTS Of the total sample, 38 patients (8%) were diagnosed with IE. No significant difference was detected (p = 0.496) in comparing the occurrence of IE in the group with dental preparation (6.4%) and without dental preparation (8.4%). The logistic regression model confirmed that dental treatment did not change the IE risk (p = 0.504) and indicated that age (p < 0.003) and gender (p = 0.013) were significant risk factors for IE. There was a high demand for dental procedures in the group receiving dental preparation, with no significant differences between the patients with or without IE. Hemoculture indicated qualitative differences in comparing patients with and without dental treatment, especially in the frequency of Staphylococcus and Streptococcus. CONCLUSIONS The results did not allow for the determination of the impact of dental treatment before CVS on IE outcomes. However, it was not possible to exclude the potential beneficial effects of dental treatment in the prevention of IE.
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Affiliation(s)
- Alessandra Figueiredo de Souza
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Amanda Leal Rocha
- Department of Oral Surgery and Pathology, Faculty of Dentistry, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Wagner Henriques Castro
- Department of Oral Surgery and Pathology, Faculty of Dentistry, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Fernanda Morais Ferreira
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Claudio Léo Gelape
- Department of Surgery, Faculty of Medicine, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Denise Vieira Travassos
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Tarcília Aparecida da Silva
- Department of Oral Surgery and Pathology, Faculty of Dentistry, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
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Deng S, Wang Y, Sun W, Chen H, Wu G. Scaling and root planning, and locally delivered minocycline reduces the load of Prevotella intermedia in an interdependent pattern, correlating with symptomatic improvements of chronic periodontitis: a short-term randomized clinical trial. Ther Clin Risk Manag 2015; 11:1795-803. [PMID: 26676022 PMCID: PMC4675638 DOI: 10.2147/tcrm.s93982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background To evaluate the respective or combinatory efficacy of locally delivered 2% minocycline (MO), and scaling and root planning (SRP) by assessing both clinical parameters and the loads of four main periodontal pathogens in treating chronic periodontitis (CP). Methods Seventy adults with CP were randomly assigned to the three treatment groups: 1) SRP alone; 2) MO alone; and 3) combinatory use of SRP and MO (SRP + MO). Before and 7 days after the treatments, we evaluated both clinical parameters (pocket depth [PD] and sulcus bleeding index [SBI]) and the gene load of four main periodontal pathogens (Aggregatibacter actinomycetemcomitans [Aa], Fusobacterium nucleatum [Fn], Porphyromonas gingivalis [Pg], and Prevotella intermedia [Pi]). Results The bacterial prevalence per patient was: Aa, 31.25%; Fn, 100%; Pg, 95.31%; and Pi, 98.44%. Seven days after treatment, the three treatments significantly reduced both PD and SBI, but not detection frequencies of the four pathogens. For PD, the reduction efficacy of SRP + MO was significantly higher than that of either MO or SRP. Only Pg responded significantly to SRP. Pg and Fn were significantly reduced in the presence of MO. Only SRP + MO showed a significant reduction effect on the gene load of Pi. The reduction of PD significantly correlated with the gene load of Pi (r=0.26; P=0.042) but not of the other bacteria. Conclusion SRP and MO reduced the load of Pi in an interdependent pattern, which correlated with symptomatic improvements of CP.
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Affiliation(s)
- Shuli Deng
- Department of Conservative Dentistry, Affiliated Hospital of Stomatology, Medical College, Zhejiang University, Hangzhou, People's Republic of China
| | - Ying Wang
- Department of Conservative Dentistry, Affiliated Hospital of Stomatology, Medical College, Zhejiang University, Hangzhou, People's Republic of China
| | - Wei Sun
- Department of Conservative Dentistry, Affiliated Hospital of Stomatology, Medical College, Zhejiang University, Hangzhou, People's Republic of China
| | - Hui Chen
- Department of Conservative Dentistry, Affiliated Hospital of Stomatology, Medical College, Zhejiang University, Hangzhou, People's Republic of China
| | - Gang Wu
- Department of Oral Implantology and Prosthetic Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), VU University Amsterdam and University of Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, the Netherlands
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Barbosa M, Prada-López I, Álvarez M, Amaral B, de los Angeles CDCM, Tomás I. Post-tooth extraction bacteraemia: a randomized clinical trial on the efficacy of chlorhexidine prophylaxis. PLoS One 2015; 10:e0124249. [PMID: 25955349 PMCID: PMC4425363 DOI: 10.1371/journal.pone.0124249] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 02/24/2015] [Indexed: 12/20/2022] Open
Abstract
Objectives To investigate the development of post-extraction bacteraemia (PEB) after the prophylactic use of chlorhexidine (CHX). Patients and Methods A total of 201 patients who underwent a tooth extraction were randomly distributed into four groups: 52 received no prophylaxis (CONTROL), 50 did a mouthwash with 0.2% CHX before the tooth extraction (CHX-MW), 51 did a mouthwash with 0.2% CHX and a subgingival irrigation with 1% CHX (CHX-MW/SUB_IR) and 48 did a mouthwash with 0.2% CHX and a continuous supragingival irrigation with 1% CHX (CHX-MW/SUPRA_IR). Peripheral venous blood samples were collected at baseline, 30 seconds after performing the mouthwash and the subgingival or supragingival irrigation, and at 30 seconds and 15 minutes after completion of the tooth extraction. Blood samples were analysed applying conventional microbiological cultures under aerobic and anaerobic conditions performing bacterial identification of the isolates. Results The prevalences of PEB in the CONTROL, CHX-MW, CHX-MW/SUB_IR and CHX-MWSUPRA_IR groups were 52%, 50%, 55% and 50%, respectively, at 30 seconds and 23%, 4%, 10% and 27%, respectively, at 15 minutes. The prevalence of PEB at 15 minutes was significantly higher in the CONTROL group than in the CHX-MW group (23% versus 4%; p = 0.005). At the same time, no differences were found between CONTROL group and CHX-MW/SUB_IR or CHX-MW/SUPRA_IR groups. Streptococci (mostly viridans group streptococci) were the most frequently identified bacteria (69–79%). Conclusions Performing a 0.2% CHX mouthwash significantly reduces the duration of PEB. Subgingival irrigation with 1% CHX didn’t increase the efficacy of the mouthwash while supragingival irrigation even decreased this efficacy, probably due to the influence of these maneuvers on the onset of bacteraemia. Clinical Relevance These results confirm the suitability of performing a mouthwash with 0.2% CHX before tooth extractions in order to reduce the duration of PEB. This practice should perhaps be extended to all dental manipulations. Trial Registration Clinicaltrials.gov NCT02150031
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Affiliation(s)
- Mario Barbosa
- School of Dentistry, Instituto Superior de Ciências da Saúde-Norte, Centro de Investigação de Ciências da Saúde, Gandra, Portugal
| | - Isabel Prada-López
- Oral Sciences Research Group, Special Needs Unit, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Barbas Amaral
- Department of Stomatology and Maxilo-Facial Surgery, St. António General Hospital, Oporto, Portugal
| | - Casares-De-Cal María de los Angeles
- Oral Sciences Research Group, Special Needs Unit, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Inmaculada Tomás
- Oral Sciences Research Group, Special Needs Unit, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
- * E-mail:
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