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Analysis of the Validity of Perioperative Antibiotic Prophylaxis in Maxillofacial Surgery. J Clin Med 2022; 11:jcm11195812. [PMID: 36233680 PMCID: PMC9573060 DOI: 10.3390/jcm11195812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 11/29/2022] Open
Abstract
Perioperative antibiotic prophylaxis is the standard in surgical departments. The type of operation, the duration of the procedure, the degree of microbiological purity of the operating field and the current clinical condition of the patient determine its administration. The aim of this study was to validate the antibiotic prophylaxis used in a Maxillofacial Surgery Department for a group of trauma and non-trauma patients. To that end, an observational prospective cohort study was carried out. The study was conducted on a group of 83 patients of the Department of Cranio-Maxillo-Facial Surgery who were divided into a group of trauma patients (n = 43) and one of non-trauma patients (n = 40). In both groups, the classic microbiological tests were carried out, and the results were analyzed in relation to: the study group, age, sex, duration of surgery, type of surgical access. Most bacterial strains were isolated at the initial stage of the operation. Gram (+) cocci were isolated more often in the trauma group and Gram (-) rods in the non-trauma group. Significantly more often, strains of fungi were noted in the initial stage of the procedure in the trauma group. We conclude that the use of perioperative antibiotic prophylaxis in the Maxillofacial Surgery Departments is justified.
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2
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Amorgianos D, Chen HM, Walker N. Streptococcus mitis infective endocarditis in a patient with ventricular septal defect and orthodontic appliances. BMJ Case Rep 2022; 15:e248349. [PMID: 35236702 PMCID: PMC8895952 DOI: 10.1136/bcr-2021-248349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/04/2022] Open
Abstract
We describe a case of a girl in a remote and rural location in Scotland with a perimembranous ventricular septal defect and orthodontic appliances, who developed right-sided infective endocarditis from Streptococcus mitis due to abrasion of the oral mucosa from the arch wire following its adjustment in the dental clinic.Fitting and adjustment of orthodontic appliances are not considered to be high-risk dental procedures and antibiotic prophylaxis is not recommended even for patients at highest risk for infective endocarditis.
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Affiliation(s)
| | - Hui Min Chen
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Niki Walker
- Scottish Adult Congenital Cardiac Service, Golden Jubilee National Hospital West of Scotland Regional Heart and Lung Centre, Glasgow, UK
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3
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Salgado-Peralvo AO, Peña-Cardelles JF, Kewalramani N, Garcia-Sanchez A, Mateos-Moreno MV, Velasco-Ortega E, Ortiz-García I, Jiménez-Guerra Á, Végh D, Pedrinaci I, Monsalve-Guil L. Is Antibiotic Prophylaxis Necessary before Dental Implant Procedures in Patients with Orthopaedic Prostheses? A Systematic Review. Antibiotics (Basel) 2022; 11:93. [PMID: 35052970 PMCID: PMC8773220 DOI: 10.3390/antibiotics11010093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/28/2021] [Accepted: 01/10/2022] [Indexed: 12/10/2022] Open
Abstract
As the population ages, more and more patients with orthopaedic prostheses (OPs) require dental implant treatment. Surveys of dentists and orthopaedic surgeons show that prophylactic antibiotics (PAs) are routinely prescribed with a very high frequency in patients with OPs who are about to undergo dental procedures. The present study aims to determine the need to prescribe prophylactic antibiotic therapy in patients with OPs treated with dental implants to promote their responsible use and reduce the risk of antimicrobial resistance. An electronic search of the MEDLINE database (via PubMed), Web of Science, LILACS, Google Scholar, and OpenGrey was carried out. The criteria used were those described by the PRISMA® Statement. No study investigated the need to prescribe PAs in patients with OPs, so four studies were included on the risk of infections of OPs after dental treatments with varying degrees of invasiveness. There is no evidence to suggest a relationship between dental implant surgeries and an increased risk of OP infection; therefore, PAs in these patients are not justified. However, the recommended doses of PAs in dental implant procedures in healthy patients are the same as those recommended to avoid infections of OPs.
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Affiliation(s)
- Angel-Orión Salgado-Peralvo
- Department of Stomatology, University of Seville, 41009 Seville, Spain; (A.-O.S.-P.); (E.V.-O.); (I.O.-G.); (Á.J.-G.); (L.M.-G.)
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain;
| | - Juan-Francisco Peña-Cardelles
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain;
- Department of Basic Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
- Fellow Oral and Maxillofacial Surgery Department and Prosthodontics Department, School of Dental Medicine, University of Connecticut Health, Farmington, CT 06030, USA
| | - Naresh Kewalramani
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain;
- Department of Nursery and Stomatology, Rey Juan Carlos University, 28922 Madrid, Spain
| | - Alvaro Garcia-Sanchez
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, University of Connecticut Health, Farmington, CT 06030, USA;
| | - María-Victoria Mateos-Moreno
- Department of Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain;
| | - Eugenio Velasco-Ortega
- Department of Stomatology, University of Seville, 41009 Seville, Spain; (A.-O.S.-P.); (E.V.-O.); (I.O.-G.); (Á.J.-G.); (L.M.-G.)
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain;
| | - Iván Ortiz-García
- Department of Stomatology, University of Seville, 41009 Seville, Spain; (A.-O.S.-P.); (E.V.-O.); (I.O.-G.); (Á.J.-G.); (L.M.-G.)
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain;
| | - Álvaro Jiménez-Guerra
- Department of Stomatology, University of Seville, 41009 Seville, Spain; (A.-O.S.-P.); (E.V.-O.); (I.O.-G.); (Á.J.-G.); (L.M.-G.)
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain;
| | - Dániel Végh
- Department of Prosthodontics, Semmelweis University, 1085 Budapest, Hungary;
- Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, 8010 Graz, Austria
| | - Ignacio Pedrinaci
- Section of Graduate Periodontology, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain;
- Department of Restorative Dentistry and Biomaterials Science, Harvard School of Dental Medicine, Harvard University, Boston, MA 02115, USA
| | - Loreto Monsalve-Guil
- Department of Stomatology, University of Seville, 41009 Seville, Spain; (A.-O.S.-P.); (E.V.-O.); (I.O.-G.); (Á.J.-G.); (L.M.-G.)
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain;
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4
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Costa CPS, Alves MS, Lima-Neto LG, Valois EM, Monteiro-Neto V, Souza SFC. Is there bacterial infection in the intact crowns of teeth with pulp necrosis of sickle cell anaemia patients? A case series study nested in a cohort. Int Endod J 2021; 54:817-825. [PMID: 33434310 DOI: 10.1111/iej.13476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the presence of bacteria in permanent teeth with intact crowns (without caries, periodontal disease or dental trauma) in patients with sickle cell anaemia (HbSS genotype) by analysing their clinical, imaging and microbiological parameters. METHODOLOGY This is a case series study nested in a cohort. In the first follow-up of this cohort study (Journal of Endodontics, 2013, 39, 177), 10 HbSS patients with at least one tooth with an intact crown and clinically diagnosed with pulp necrosis by pulse oximetry adapted for dentistry and a cold pulp sensitivity test (n = 27 teeth) were selected. Changes in the pulp chamber, root and periodontal ligament were identified in the tomographic analysis. Bacterial culture, staining for live and dead bacteria, and real-time polymerase chain reaction with 16S rRNA primers were used to identify the presence of bacteria. Culture sample collection was performed immediately after access to the pulp chamber. The microbiome was analysed with a MiSeq sequencer (Illumina, San Diego, CA). RESULTS The diagnosis of pulp necrosis was confirmed clinically in 82% (22/27) of the teeth. The amount of bacterial load identified was less than 100 copies μL-1 in 23% (5/22) of the teeth with intact crowns and pulp necrosis. Thirteen bacterial species were identified that are commonly found in urinary tract infections, septicaemia and infective endocarditis. Only one of these species, Granulicatella adjacens, has also be found in primary endodontic infections. CONCLUSION Prospective clinical, imaging and microbiological analyses suggest that pulp necrosis of teeth with intact crowns in HbSS patients is not associated with the presence of bacteria.
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Affiliation(s)
- C P S Costa
- School of Dentistry, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - M S Alves
- Parasitic Biology Postgraduate, CEUMA University, São Luís, Maranhão, Brazil
| | - L G Lima-Neto
- Parasitic Biology Postgraduate, CEUMA University, São Luís, Maranhão, Brazil
| | - E M Valois
- School of Dentistry, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - V Monteiro-Neto
- Department of Pathology, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - S F C Souza
- School of Dentistry, Federal University of Maranhão, São Luís, Maranhão, Brazil
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Marttila E, Grönholm L, Saloniemi M, Rautemaa-Richardson R. Prevalence of bacteraemia following dental extraction - efficacy of the prophylactic use of amoxicillin and clindamycin. Acta Odontol Scand 2021; 79:25-30. [PMID: 32449864 DOI: 10.1080/00016357.2020.1768285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To evaluate the efficacy of single-dose antibiotic prophylaxis (AP) in the prevention of bacteraemia following tooth extractions at our clinic. MATERIAL AND METHODS Fifty patients undergoing tooth extractions were enrolled. The need of AP was determined according to the health status and possible allergies of the patients. Blood culture samples were collected at baseline, 5 min after the first tooth extraction and 20 min after the last extraction. RESULTS The majority (76%) received prophylactic oral amoxicillin or intravenous ampicillin (AMX/AMP) (2 g), 12% received clindamycin (CLI) (600 mg) and 12% received no prophylaxis (NO AP). All baseline blood cultures were reported negative. The prevalence of bacteraemia was significantly higher in the CLI and NO AP groups compared to the AMX/AMP group 5 min after the first tooth extraction (p < .0001 and p = .015, respectively). Twenty minutes after the last extraction positive blood cultures were reported only for CLI (p = .0015) and NO AP groups. There was no significant difference in the prevalence of positive blood cultures between CLI and NO AP groups. CONCLUSIONS Appropriately administered AMX/AMP proved its efficacy in reducing both the prevalence and duration of bacteraemia following tooth extractions whereas CLI was not effective in preventing bacteraemia following tooth extractions.
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Affiliation(s)
- Emilia Marttila
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Mikko Saloniemi
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Riina Rautemaa-Richardson
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Infectious Diseases and Mycology Reference Centre Manchester, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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6
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Butera A, Maiorani C, Natoli V, Bruni A, Coscione C, Magliano G, Giacobbo G, Morelli A, Moressa S, Scribante A. Bio-Inspired Systems in Nonsurgical Periodontal Therapy to Reduce Contaminated Aerosol during COVID-19: A Comprehensive and Bibliometric Review. J Clin Med 2020; 9:jcm9123914. [PMID: 33276626 PMCID: PMC7761598 DOI: 10.3390/jcm9123914] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/25/2020] [Accepted: 11/29/2020] [Indexed: 12/13/2022] Open
Abstract
Background: On 30 January 2020, a public health emergency of international concern was declared as a result of the new COVID-19 disease, caused by the SARS-CoV-2 virus. This virus is transmitted by air and, therefore, clinical practices with the production of contaminant aerosols are highly at risk. The purpose of this review was to assess the effectiveness of bio-inspired systems, as adjuvants to nonsurgical periodontal therapy, in order to formulate bio-inspired protocols aimed at restoring optimal condition, reducing bacteremia and aerosols generation. Methods: A comprehensive and bibliometric review of articles published in English. Research of clinical trials (RCTs) were included with participants with chronic or aggressive periodontal disease, that have compared benefits for nonsurgical periodontal therapy (NSPT). Results: Seventy-four articles have been included. For probing depth (PPD) there was a statically significant improvement in laser, probiotic, chlorhexidine groups, such as gain in clinical attachment level (CAL). Bleeding on probing (BOP) reduction was statistically significant only for probiotic and chlorhexidine groups. There were changes in microbiological and immunological parameters. Conclusions: The use of bio-inspired systems in nonsurgical periodontal treatment may be useful in reducing risk of bacteremia and aerosol generation, improving clinical, microbiological and immunological parameters, of fundamental importance in a context of global pandemic, where the reduction of bacterial load in aerosols becomes a pivotal point of clinical practice, but other clinical trials are necessary to achieve statistical validity.
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Affiliation(s)
- Andrea Butera
- Unit of Dental Hygiene, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
- Correspondence:
| | - Carolina Maiorani
- Unit of Dental Hygiene, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
| | | | | | | | | | | | | | | | - Andrea Scribante
- Unit of Orthodontics and Pediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
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7
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Effect of antiseptic gels in the microbiologic colonization of the suture threads after oral surgery. Sci Rep 2020; 10:8360. [PMID: 32433572 PMCID: PMC7239853 DOI: 10.1038/s41598-020-65007-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 04/22/2020] [Indexed: 11/30/2022] Open
Abstract
Three different bioadhesive gels were evaluated in a double-blind randomized clinical trial in which microbial growth in the suture thread was assessed following post-surgical application of the aforementioned gels. Also assessed in this trial were, the intensity of post-surgical pain as well as the degree of healing of the patients’ surgical wounds. A total of 21 patients (with 42 wisdom teeth) participated in this trial. Chlorhexidine gel, chlorhexidine-chitosan gel, and hyaluronic acid gel were evaluated, with a neutral water-based gel serving as the control agent. The aerobic and facultative anaerobic bacterial recovery on blood agar was lower in the placebo group than in the experimental groups. The most significant difference (p = 0.04) was observed in the chlorhexidine-chitosan group. in which the growth of Blood Agar and Mitis Salivarius Agar was significantly higher than in the placebo group. The intensity of post-surgical pain was very similar among all the groups. Significantly better healing rates were observed in the patients treated with chlorhexidine-chitosan gel when compared with those who used the placebo gel (p = 0.03), and in particular when compared with those patients who used hyaluronic acid gel (p = 0.01). Through our microbiological analyses, we were able to conclude that none of the bioadhesive gels tested resulted in beneficial reductions in the bacterial/fungal populations. However, the healing rates of patients who were treated with chlorhexidine-chitosan were better than those of the patients who used either the placebo gel or the hyaluronic acid gel.
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8
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Culture-independent Characterization of the Microbiome of Healthy Pulp. J Endod 2018; 44:1132-1139.e2. [DOI: 10.1016/j.joen.2018.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 02/08/2023]
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9
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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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10
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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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11
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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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12
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Sidana S, Mistry Y, Gandevivala A, Motwani N. Evaluation of the Need for Antibiotic Prophylaxis During Routine Intra-alveolar Dental Extractions in Healthy Patients: A Randomized Double-Blind Controlled Trial. J Evid Based Dent Pract 2017; 17:184-189. [DOI: 10.1016/j.jebdp.2017.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/20/2017] [Accepted: 04/20/2017] [Indexed: 11/26/2022]
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13
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Pippi R. Antibiotic prophylaxis for infective endocarditis: some rarely addressed issues. Br Dent J 2017; 222:583-587. [DOI: 10.1038/sj.bdj.2017.356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2017] [Indexed: 11/09/2022]
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14
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Bacteremia Associated With Oral Surgery: A Review. J Evid Based Dent Pract 2016; 17:190-204. [PMID: 28865816 DOI: 10.1016/j.jebdp.2016.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 12/02/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Bacterial (infective) endocarditis, a microbial infection of the endocardium surfaces after bacteremia, causes significant morbidity and mortality. Recent epidemiologic studies have reported a prevalence of 2-8 cases per 100,000 individuals per year, with the highest incidence in those aged 70-80 years and those living in developed countries. We systematically reviewed the literature on several critical aspects regarding the development of bacteremia after oral surgery. The purpose of this work is to assess the controversy regarding antibiotic prophylaxis before oral surgery. MATERIALS AND METHODS Publications between 1976 and 2015 were included. Clinical studies focusing on oral surgery as the underlying cause were included. RESULTS Among the 32 clinical studies reviewed, 3564 cases, accounting for 12,839 blood cultures, were evaluated. In 10 of these studies, amoxicillin usefulness was studied. Antimicrobial prophylaxis before an invasive dental procedure does not prevent bacteremia, although it can decrease both its magnitude and its persistence. CONCLUSIONS The highly conflicting data and conclusions of the analyzed work highlight the need for new approaches to the study of bacteremia that would provide reliable evidence and thus appropriate prophylactic and therapeutic standards. Many reports have explored the occurrence of bacteremia after dental procedures, but the results have been conflicting.
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15
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Carmona IT, Diz Dios P, Scully C. Efficacy of Antibiotic Prophylactic Regimens for the Prevention of Bacterial Endocarditis of Oral Origin. J Dent Res 2016; 86:1142-59. [DOI: 10.1177/154405910708601203] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Despite the controversy about the risk of individuals developing bacterial endocarditis of oral origin, numerous Expert Committees in different countries continue to publish prophylactic regimens for the prevention of bacterial endocarditis secondary to dental procedures. In this paper, we analyze the efficacy of antibiotic prophylaxis in the prevention of bacteremia following dental manipulations and in the prevention of bacterial endocarditis (in both animal models and human studies). Antibiotic prophylaxis guidelines remain consensus-based, and there is scientific evidence of the efficacy of amoxicillin in the prevention of bacteremia following dental procedures, although the results reported do not confirm the efficacy of other recommended antibiotics. The majority of studies on experimental models of bacterial endocarditis have verified the efficacy of antibiotics administered after the induction of bacteremia, confirming the efficacy of antibiotic prophylaxis in later stages in the development of bacterial endocarditis. There is no scientific evidence that prophylaxis with penicillin is effective in reducing bacterial endocarditis secondary to dental procedures in patients considered to be "at risk". It has been suggested that there is a high risk of severe allergic reactions secondary to prophylactically administered penicillins, but, in reality, very few cases have been reported in the literature. It has been demonstrated that antibiotic prophylaxis could contribute to the development of bacterial resistance, but only after the administration of several consecutive doses. Future research on bacterial endocarditis prophylactic protocols should involve the re-evaluation of the time and route of administration of antibiotic prophylaxis, and a search for alternative antimicrobials.
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Affiliation(s)
- I. Tomás Carmona
- Special Needs Unit, School of Medicine and Dentistry, Santiago de Compostela University -Spain-; and
- Eastman Dental Institute, University College London, 256 Gray’s Inn Road, London WC1X 8LD, UK
| | - P. Diz Dios
- Special Needs Unit, School of Medicine and Dentistry, Santiago de Compostela University -Spain-; and
- Eastman Dental Institute, University College London, 256 Gray’s Inn Road, London WC1X 8LD, UK
| | - C. Scully
- Special Needs Unit, School of Medicine and Dentistry, Santiago de Compostela University -Spain-; and
- Eastman Dental Institute, University College London, 256 Gray’s Inn Road, London WC1X 8LD, UK
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Dental hygiene in maintaining a healthy joint replacement: a survey of Canadian total joint replacement patients. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Sendi P, Uçkay I, Suvà D, Vogt M, Borens O, Clauss M. Antibiotic Prophylaxis During Dental Procedures in Patients with Prosthetic Joints. J Bone Jt Infect 2016; 1:42-49. [PMID: 28529852 PMCID: PMC5423560 DOI: 10.7150/jbji.16318] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 07/13/2016] [Indexed: 11/06/2022] Open
Abstract
In patients with artificial joints, the need for antimicrobial prophylaxis during dental procedures is often raised. The present document describes the pathogenic mechanisms and epidemiological data on the subject of periprosthetic joint infections (PJI) after dental procedures. The document reflects the opinion and recommendations of the expert group 'Infection' of Swiss Orthopaedics. Microorganisms belonging to oral flora can seed haematogenously to an artificial joint. The proof of a causative relation with dental procedures is not possible, because the responsible bacteraemia can originate from the oral cavity at any time, irrespective of when the dental procedure occurs. Good oral hygiene is associated with a lower risk for PJI. Transient bacteraemia occurs during daily oral hygiene activity (e.g., tooth brushing) and thus the cumulative risk for a haematogenous PJI from tooth brushing is higher than that from a dental procedure. PJI after a dental procedure are rarely reported. On the basis of an epidemiological model, several thousand patients with artificial joints must receive antimicrobial prophylaxis to prevent a single PJI. Considering this ratio, the number of adverse events due to the antimicrobial compound exceeds the benefit of administering it by a large magnitude. Therefore, as a rule for the vast majority of cases, antimicrobial prophylaxis during dental procedures is not recommended. It is important that a patient has a good oral health status before joint implantation and that good oral hygiene is continuously maintained in patients with artificial joints.
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Affiliation(s)
- Parham Sendi
- Department of Infectious Diseases, Bern University Hospital, University of Bern
- Institute for Infectious Diseases, Faculty of Medicine, University of Bern
| | - Ilker Uçkay
- Service of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva
- Orthopedic Surgery Service, Geneva University Hospitals and Faculty of Medicine, University of Geneva
| | - Domizio Suvà
- Orthopedic Surgery Service, Geneva University Hospitals and Faculty of Medicine, University of Geneva
| | - Markus Vogt
- Infectious Diseases Service, Cantonal Hospital Zug, Baar
| | - Olivier Borens
- Orthopedic Septic Surgical Unit, Department of Surgery and Anesthesiology, Lausanne University Hospital, Lausanne
| | - Martin Clauss
- Clinic for Orthopedics and Trauma Surgery and Interdisciplinary Septic Surgical Unit, Kantonsspital Baselland Liestal, Switzerland
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Reyes L, Herrera D, Kozarov E, Roldán S, Progulske-Fox A. Periodontal bacterial invasion and infection: contribution to atherosclerotic pathology. J Clin Periodontol 2016; 40 Suppl 14:S30-50. [PMID: 23627333 DOI: 10.1111/jcpe.12079] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this review was to perform a systematic evaluation of the literature reporting current scientific evidence for periodontal bacteria as contributors to atherosclerosis. METHODS Literature from epidemiological, clinical and experimental studies concerning periodontal bacteria and atherosclerosis were reviewed. Gathered data were categorized into seven "proofs" of evidence that periodontal bacteria: 1) disseminate from the oral cavity and reach systemic vascular tissues; 2) can be found in the affected tissues; 3) live within the affected site; 4) invade affected cell types in vitro; 5) induce atherosclerosis in animal models of disease; 6) non-invasive mutants of periodontal bacteria cause significantly reduced pathology in vitro and in vivo; and 7) periodontal isolates from human atheromas can cause disease in animal models of infection. RESULTS Substantial evidence for proofs 1 to 6 was found. However, proof 7 has not yet been fulfilled. CONCLUSIONS Despite the lack of evidence that periodontal bacteria obtained from human atheromas can cause atherosclerosis in animal models of infection, attainment of proofs 1 to 6 provides support that periodontal pathogens can contribute to atherosclerosis.
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Affiliation(s)
- Leticia Reyes
- Department of Oral Biology, College of Dentistry and Center for Molecular Microbiology, University of Florida, Gainesville, FL 32610-0424, USA
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Baltimore RS, Gewitz M, Baddour LM, Beerman LB, Jackson MA, Lockhart PB, Pahl E, Schutze GE, Shulman ST, Willoughby R. Infective Endocarditis in Childhood: 2015 Update. Circulation 2015; 132:1487-515. [DOI: 10.1161/cir.0000000000000298] [Citation(s) in RCA: 201] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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20
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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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Ugwumba CU, Adeyemo WL, Odeniyi OM, Arotiba GT, Ogunsola FT. Preoperative administration of 0.2% chlorhexidine mouthrinse reduces the risk of bacteraemia associated with intra-alveolar tooth extraction. J Craniomaxillofac Surg 2014; 42:1783-8. [DOI: 10.1016/j.jcms.2014.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 06/03/2014] [Accepted: 06/06/2014] [Indexed: 10/25/2022] Open
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Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014. [DOI: 10.1007/s00103-014-1980-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Diz Dios P. Infective endocarditis prophylaxis. Oral Dis 2014; 20:325-8. [PMID: 24373017 DOI: 10.1111/odi.12221] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 12/13/2013] [Indexed: 11/29/2022]
Abstract
Antibiotic prophylaxis for infective endocarditis continues to be administered empirically, although its indications are ever more restrictive. Some expert committees have even suggested that antibiotic prophylaxis is unnecessary, rekindling the controversy between those who defend the scientific evidence and those working in clinical practice; in any case, this proposal will facilitate the undertaking of prospective placebo-controlled trials, so necessary to resolve this issue. In the meantime, the most prudent approach is to adopt the recommendations proposed by the expert committees in each country.
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Affiliation(s)
- P Diz Dios
- OMEQUI Research Group, School of Medicine and Dentistry, Santiago de Compostela University, Santiago de Compostela, Spain
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24
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Yagci A, Uysal T, Demirsoy KK, Percin D. Relationship between odontogenic bacteremia and orthodontic stripping. Am J Orthod Dentofacial Orthop 2013; 144:73-7. [DOI: 10.1016/j.ajodo.2013.02.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 02/01/2013] [Accepted: 02/01/2013] [Indexed: 11/26/2022]
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The comparative efficacy of 0.12% chlorhexidine and amoxicillin to reduce the incidence and magnitude of bacteremia during third molar extractions: a prospective, blind, randomized clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:752-63. [DOI: 10.1016/j.oooo.2012.11.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 11/20/2012] [Indexed: 11/18/2022]
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Álvarez J, Castro M, Feijoo JF, Diz P. Prevention of infective endocarditis from the dentist's perspective. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2013; 66:416. [PMID: 24775832 DOI: 10.1016/j.rec.2012.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 12/18/2012] [Indexed: 06/03/2023]
Affiliation(s)
- Javier Álvarez
- Grupo de Investigación en Odontología Médico-Quirúrgica (OMEQUI), Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
| | - Miguel Castro
- Grupo de Investigación en Odontología Médico-Quirúrgica (OMEQUI), Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
| | - Javier F Feijoo
- Grupo de Investigación en Odontología Médico-Quirúrgica (OMEQUI), Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
| | - Pedro Diz
- Grupo de Investigación en Odontología Médico-Quirúrgica (OMEQUI), Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain.
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Álvarez J, Castro M, Feijoo JF, Diz P. Prevención de la endocarditis infecciosa desde la perspectiva del dentista. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Maharaj B, Coovadia Y, Vayej AC. A comparative study of amoxicillin, clindamycin and chlorhexidine in the prevention of post-extraction bacteraemia. Cardiovasc J Afr 2013; 23:491-4. [PMID: 23108516 PMCID: PMC3721912 DOI: 10.5830/cvja-2012-049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 06/05/2012] [Indexed: 11/06/2022] Open
Abstract
We evaluated some of the regimens recommended for the antimicrobial prophylaxis of infective endocarditis prior to dental extraction in 160 patients. Group A patients served as the control group, group B subjects rinsed their mouths with chlorhexidene, group C subjects took 3 g amoxicillin orally and group D patients took 600 mg clindamycin orally. The proportion of patients who had post-extraction bacteraemia in groups A, B, C and D was 35, 40, 7.5 and 20%, respectively. The differences between the control and amoxicillin groups (p = 0.003) and between the chlorhexidine and amoxicillin groups (p = 0.0006) were statistically significant. Streptococci were not isolated in any patients in the amoxicillin and clindamycin groups. In our study, none of the regimens were effective in preventing post-extraction bacteraemia.
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Affiliation(s)
- Breminand Maharaj
- Department of Therapeutics and Medicines Management, University of KwaZulu-Natal, Durban, South Africa.
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29
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Abstract
The Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures evidence-based clinical practice guideline was codeveloped by the American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association. This guideline replaces the previous AAOS Information Statement, "Antibiotic Prophylaxis in Bacteremia in Patients With Joint Replacement," published in 2009. Based on the best current evidence and a systematic review of published studies, three recommendations have been created to guide clinical practice in the prevention of orthopaedic implant infections in patients undergoing dental procedures. The first recommendation is graded as Limited; this recommendation proposes that the practitioner consider changing the long-standing practice of routinely prescribing prophylactic antibiotic for patients with orthopaedic implants who undergo dental procedures. The second, graded as Inconclusive, addresses the use of oral topical antimicrobials in the prevention of periprosthetic joint infections. The third recommendation, a Consensus statement, addresses the maintenance of good oral hygiene.
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Abstract
BACKGROUND Secondary antimicrobial prophylaxis involves the use of ≥ 1 antimicrobial agent just prior to the time when a diagnostic/therapeutic procedure, which may induce infection, is to be performed. In the context of this article, antimicrobial agent(s) are administered to patients with ≥ 1 implanted prosthetic device in order to prevent metastatic seeding of the device(s) during bacteremia induced by a diagnostic/therapeutic procedure. Antimicrobial agents used in this context are only administered periprocedurally. Secondary antimicrobial prophylaxis of endocarditis in recipients of cardiac prosthetic materials (including valves, shunts, conduits, and patches) has been reasonably well established. However, secondary antimicrobial prophylaxis in recipients of other types of prosthetic devices has been the subject of much controversy, with a wide variety of recommendations being made. OBJECTIVES The purpose of this article was to conduct a narrative review of the published literature on the topic of secondary antimicrobial prophylaxis in recipients of noncardiac prosthetic devices and make evidence-based recommendations for each type of device, where possible. METHODS Medline/PubMed and EMBASE databases were searched for English-language articles published from 1950 to the present (January 2012). Search terms included "prophylaxis," "antibiotics," "antimicrobials," "prosthetic devices," "prosthesis-related infections," "bacteremia," the names of the individual types of prosthetic devices, and the names of the individual procedures potentially inducing bacteremia. Articles dealing with any aspect relevant to this topic were eligible for review. The bibliographies of retrieved articles were also carefully scanned to identify any articles not previously identified. RESULTS Based on review of the available literature, secondary antimicrobial prophylaxis is justified in only a few specific circumstances. For recipients of prosthetic vascular grafts/stents, hemodialysis arteriovenous shunts, and ventriculoatrial/ventriculovenous shunts, prophylaxis is warranted during the initial 6 months, initial 6 weeks, and at all times after implantation/revision, respectively, when dental procedures capable of inducing high-level bacteremia are planned. Prosthetic joint recipients should receive prophylaxis in the following 3 circumstances: 1) patient is to undergo dental procedure(s) capable of inducing high-level bacteremia plus either the patient is still within 2 years of device implantation/revision or the patient has ≥ 1 risk factor for hematogenous prosthetic joint infection; 2) patient is to undergo genitourinary tract procedure(s) capable of inducing high-level bacteremia plus the patient has ≥ 1 risk factor for high-risk bacteriuria; and 3) patient is to undergo perforating dermatologic surgery on the oral mucosa or at skin sites at increased risk for surgical site infection plus patient has ≥ 1 risk factor for hematogenous prosthetic joint infection. The data are inadequate to justify secondary antimicrobial prophylaxis for recipients of other types of prosthetic devices. On the basis of 9 surveys of prescriber behavior, it is apparent that there exists, over a wide geographic area, a wide disconnect between clinical practice and the secondary antimicrobial prophylaxis guidelines issued by the professional organizations representing these prescribers. Antimicrobial agent overuse was especially problematic among orthopedic and colorectal surgeons, urologists, and family practitioners. Dentists and maxillofacial surgeons followed guidelines more closely. CONCLUSION Device-, procedure-, and patient characteristic-dependent factors elicited over many years have narrowed down the secondary antimicrobial prophylaxis recommendations for noncardiac prosthetic devices to a small number. Despite this, physician prescribers frequently do not follow prophylaxis guidelines established by their own professional organizations. Risk-benefit and cost-effectiveness studies have found that no prophylaxis is actually superior to universal prophylaxis, likely due to known antimicrobial toxicities, such as anaphylactic/anaphylactoid reactions and Clostridium difficile-associated disease. Much work remains in establishing and extending the scientific basis for secondary antimicrobial prophylaxis and transforming this knowledge into appropriate action by the clinician.
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Affiliation(s)
- David R Guay
- College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA.
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Håheim LL, Olsen I, Rønningen KS. Association between tooth extraction due to infection and myocardial infarction. Community Dent Oral Epidemiol 2011; 39:393-7. [DOI: 10.1111/j.1600-0528.2011.00616.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Piñeiro A, Tomás I, Blanco J, Alvarez M, Seoane J, Diz P. Bacteraemia following dental implants' placement. Clin Oral Implants Res 2010; 21:913-8. [PMID: 20701619 DOI: 10.1111/j.1600-0501.2010.01928.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the prevalence, duration and aetiology of bacteraemias following the placement of implants as well as the prophylactic efficacy of a chlorhexidine digluconate (CHX) mouthrinse. MATERIAL AND METHODS Fifty patients undergoing implant placement were randomly distributed into two groups: CONTROL GROUP 30 patients with no prophylactic intervention before surgery. CHX group: 20 patients who performed a 0.2% CHX mouthrinse before surgery. Blood samples were collected at baseline, at 30 s after the insertion of implants and at 15 min after completion of the suturing of the mucoperiosteal flap. Samples were processed in the Bactec 9240, and the subculture and further identification of the isolates were performed using conventional microbiological techniques. RESULTS The prevalence of bacteraemias was 2% at baseline. In the control group, the prevalence of bacteraemias was 6.7% at 30 s and 3.3% at 15 min, but no statistically significant differences were achieved compared with the baseline percentage. In the CHX group, there were no positive cultures from blood samples obtained at 30 s or at 15 min. CONCLUSIONS Implant placement via a mucoperiosteal flap does not carry a significant risk of developing bacteraemias. The use of antibiotic prophylaxis for the prevention of focal infections such as bacterial endocarditis in "at-risk" patients undergoing dental implants is therefore questionable. Although its efficacy has not been confirmed statistically, we recommend a 0.2% CHX mouthrinse before treatment as proposed previously by the British Society for Antimicrobial Chemotherapy.
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Affiliation(s)
- A Piñeiro
- Department of Special Needs, School of Medicine and Dentistry, Santiago de Compostela University, Galicia, Spain
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Olsen I, Snorrason F, Lingaas E. Should patients with hip joint prosthesis receive antibiotic prophylaxis before dental treatment? J Oral Microbiol 2010; 2. [PMID: 21523226 PMCID: PMC3084562 DOI: 10.3402/jom.v2i0.5265] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2010] [Revised: 06/22/2010] [Accepted: 07/23/2010] [Indexed: 01/20/2023] Open
Abstract
The safety committee of the American Academy of Orthopedic Surgeons (AAOS) recommended in 2009 that clinicians should consider antibiotic prophylaxis for all patients with total joint replacement before any invasive procedure that may cause bacteremia. This has aroused confusion and anger among dentists asking for the evidence. The present review deals with different aspects of the rationale for this recommendation giving attention to views both in favor of and against it.
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Affiliation(s)
- Ingar Olsen
- Institute of Oral Biology, University of Oslo, Oslo, Norway
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Meurman JH. Oral microbiota and cancer. J Oral Microbiol 2010; 2. [PMID: 21523227 PMCID: PMC3084564 DOI: 10.3402/jom.v2i0.5195] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2010] [Revised: 06/29/2010] [Accepted: 06/29/2010] [Indexed: 12/15/2022] Open
Abstract
Inflammation caused by infections may be the most important preventable cause of cancer in general. However, in the oral cavity the role of microbiota in carcinogenesis is not known. Microbial populations on mouth mucosa differ between healthy and malignant sites and certain oral bacterial species have been linked with malignancies but the evidence is still weak in this respect. Nevertheless, oral microorganisms inevitably up-regulate cytokines and other inflammatory mediators that affect the complex metabolic pathways and may thus be involved in carcinogenesis. Poor oral health associates statistically with prevalence of many types of cancer, such as pancreatic and gastrointestinal cancer. Furthermore, several oral micro-organisms are capable of converting alcohol to carcinogenic acetaldehyde which also may partly explain the known association between heavy drinking, smoking, poor oral health and the prevalence of oral and upper gastrointestinal cancer. A different problem is the cancer treatment-caused alterations in oral microbiota which may lead to the emergence of potential pathogens and subsequent other systemic health problems to the patients. Hence clinical guidelines and recommendations have been presented to control oral microbiota in patients with malignant disease, but also in this area the scientific evidence is weak. More controlled studies are needed for further conclusion.
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Affiliation(s)
- Jukka H Meurman
- Institute of Dentistry, University of Helsinki, Helsinki, Finland
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Tomás I, Cousido M, García-Caballero L, Rubido S, Limeres J, Diz P. Substantivity of a single chlorhexidine mouthwash on salivary flora: Influence of intrinsic and extrinsic factors. J Dent 2010; 38:541-6. [DOI: 10.1016/j.jdent.2010.03.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 03/23/2010] [Accepted: 03/30/2010] [Indexed: 11/16/2022] Open
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Kim DJ, Yu KH, Lim HS, Lee SK, Kim SG, Kim HK. Effect of saline irrigation used in combination with antimicrobial agents on salivary bacterial counts. J Korean Assoc Oral Maxillofac Surg 2010. [DOI: 10.5125/jkaoms.2010.36.3.202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Dong-Joo Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea
| | - Kyoung-Hwan Yu
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea
| | - Hyong-Sup Lim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea
| | - Sung-Kyu Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea
| | - Su-Gwan Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea
| | - Hak-Kyun Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea
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Oltramari-Navarro PVP, Titarelli JM, Marsicano JA, Castanha Henriques JF, Janson G, Pereira Lauris JR, Buzalaf MAR. Effectiveness of 0.50% and 0.75% chlorhexidine dentifrices in orthodontic patients: A double-blind and randomized controlled trial. Am J Orthod Dentofacial Orthop 2009; 136:651-6. [DOI: 10.1016/j.ajodo.2008.01.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2007] [Revised: 01/01/2008] [Accepted: 01/01/2008] [Indexed: 11/16/2022]
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Abstract
Periodontal disease is the most common disease in small animal patients. It not only creates severe localized infection, but it has been linked to numerous severe systemic maladies. Proper therapy of this disease process results in a significant increase in the overall health of the patient. The treatment of periodontal disease is currently evolving due to the acceptance of the specific plaque hypothesis of periodontal disease. These findings have led to the development of the "one-stage full-mouth disinfection" treatment as well as a vaccine against these organisms. However, the cornerstone of therapy is still meticulous plaque control. This control is achieved via a combination of regular dental prophylaxis and home care. With progressive disease, advanced periodontal surgery or extraction becomes necessary.
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Affiliation(s)
- Brook A Niemiec
- Southern California Veterinary Dental Specialties, San Diego, CA 92111, USA.
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