Effect of chlorhexidine mouthrinse and periodontal treatment upon bacteremia produced by oral hygiene procedures

Does chlorhexidine reduce bacteremia following tooth extraction? A systematic review and meta-analysis

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.

Dissemination of periodontal pathogens in the bloodstream after periodontal procedures: a systematic review

BACKGROUND

To date, there is no compilation of evidence-based information associating bacteremia and periodontal procedures. This systematic review aims to assess magnitude, duration, prevalence and nature of bacteremia caused by periodontal procedures.

STUDY DESIGN

Systematic Review.

TYPES OF STUDIES REVIEWED

MEDLINE, EMBASE and LILACS databases were searched in duplicate through August, 2013 without language restriction. Observational studies were included if blood samples were collected before, during or after periodontal procedures of patients with periodontitis. The methodological quality was assessed in duplicate using the modified Newcastle-Ottawa scale (NOS).

RESULTS

Search strategy identified 509 potentially eligible articles and nine were included. Only four studies demonstrated high methodological quality, whereas five were of medium or low methodological quality. The study characteristics were considered too heterogeneous to conduct a meta-analysis. Among 219 analyzed patients, 106 (49.4%) had positive bacteremia. More frequent bacteria were S. viridans, A. actinomycetemcomitans P. gingivalis, M. micros and species Streptococcus and Actinomyces, although identification methods of microbiologic assays were different among studies.

CLINICAL IMPLICATIONS

Although half of the patients presented positive bacteremia after periodontal procedures, accurate results regarding the magnitude, duration and nature of bacteremia could not be confidentially assessed.

Bacteremia associated with toothbrushing and dental extraction

BACKGROUND

Antibiotic prophylaxis recommendations for the prevention of infective endocarditis are based in part on studies of bacteremia from dental procedures, but toothbrushing may pose a greater threat. The purpose of this study was to compare the incidence, duration, nature, and magnitude of endocarditis-related bacteremia from single-tooth extraction and toothbrushing and to determine the impact of amoxicillin prophylaxis on single-tooth extraction.

METHODS AND RESULTS

In this double-blind, placebo-controlled study, 290 subjects were randomized to (1) toothbrushing, (2) single-tooth extraction with amoxicillin prophylaxis, or (3) single-tooth extraction with identical placebo. Blood was drawn for bacterial culturing and identification at 6 time points before, during, and after these interventions. The focus of our analysis was on bacterial species reported to cause infective endocarditis. We identified 98 bacterial species, 32 of which are reported to cause endocarditis. Cumulative incidence of endocarditis-related bacteria from all 6 blood draws was 23%, 33%, and 60% for the toothbrushing, extraction-amoxicillin, and extraction-placebo groups, respectively (P<0.0001). Significant differences were identified among the 3 groups at draws 2, 3, 4, and 5 (all P<0.05). Amoxicillin resulted in a significant decrease in positive cultures (P<0.0001).

CONCLUSIONS

Although amoxicillin has a significant impact on bacteremia resulting from a single-tooth extraction, given the greater frequency for oral hygiene, toothbrushing may be a greater threat for individuals at risk for infective endocarditis.