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Lean SSH, Jou E, Ho JSY, Jou EGL. Prophylactic antibiotic use for infective endocarditis: a systematic review and meta-analysis. BMJ Open 2023; 13:e077026. [PMID: 37607797 PMCID: PMC10445353 DOI: 10.1136/bmjopen-2023-077026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/10/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVES Infective endocarditis (IE) is a devastating disease with a 50% 1-year mortality rate. In recent years, medical authorities across the globe advised stricter criteria for antibiotic prophylaxis in patients with high risk of IE undergoing dental procedures. Whether such recommendations may increase the risk of IE in at-risk patients must be investigated. DESIGN Prospectively registered systematic review and meta-analysis. DATA SOURCES Medline, Embase, Scopus and ClinicalTrials.gov were searched through 23 May 2022, together with an updated search on 5 August 2023. ELIGIBILITY CRITERIA All primary studies reporting IE within 3 months of dental procedures in adults >18 years of age were included, while conference abstracts, reviews, case reports and case series involving fewer than 10 cases were excluded. DATA EXTRACTION AND SYNTHESIS All studies were assessed by two reviewers independently, and any discrepancies were further resolved through a third researcher. RESULTS Of the 3771 articles screened, 38 observational studies fit the inclusion criteria and were included in the study for subsequent analysis. Overall, 11% (95% CI 0.08 to 0.16, I2=100%) of IE are associated with recent dental procedures. Streptococcus viridans accounted for 69% (95% CI 0.46 to 0.85) of IE in patients who had undergone recent dental procedures, compared with only 21% (95% CI 0.17 to 0.26) in controls (p=0.003). None of the high-risk patients developed IE across all studies where 100% of the patients were treated with prophylactic antibiotics, and IE patients are 12% more likely to have undergone recent dental manipulation compared with matched controls (95% CI 1.00 to 1.26, p=0.048). CONCLUSIONS Although there is a lack of randomised control trials due to logistic difficulties in the literature on this topic, antibiotic prophylaxis are likely of benefit in reducing the incidence of IE in high-risk patients after dental procedures. Further well-designed high-quality case-control studies are required. TRIAL REGISTRATION NUMBER CRD42022326664.
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Affiliation(s)
- Sue S H Lean
- Department of Dental Medicine, Wei Gong Memorial Hospital, Miaoli, Taiwan
| | - Eric Jou
- Queens' College, University of Cambridge, Cambridge, UK
| | - Jamie Sin Ying Ho
- Department of Medicine, National University Health System, Singapore
| | - Ernest G L Jou
- Department of Dental Medicine, Wei Gong Memorial Hospital, Miaoli, Taiwan
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2
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Discrepancy in Therapeutic and Prophylactic Antibiotic Prescribing in General Dentists and Maxillofacial Specialists in Australia. Antibiotics (Basel) 2020; 9:antibiotics9080492. [PMID: 32784644 PMCID: PMC7459474 DOI: 10.3390/antibiotics9080492] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/29/2020] [Accepted: 08/06/2020] [Indexed: 02/07/2023] Open
Abstract
There are concerns that general dentists (GDs) and dental specialists may be prescribing antibiotics inappropriately. This study explored the prescribing habits and decision-making processes of GDs versus oral and maxillofacial surgeons (OMFSs). A case-based online questionnaire was used to examine the prescribing of therapeutic and prophylactic antibiotics in two clinical scenarios. Stratified and systematic sampling strategies were implemented to provide a representative sample. The final valid sample was 60 GDs and 18 OMFSs. The majority of OMFSs (61.1%) routinely prescribed antibiotics for the surgical removal of third molars, which was significantly greater than for GDs (23.5%). For implant placement procedures, 72.2% of OMFSs and 62.1% of GDs prescribed antibiotics. Amoxicillin was the most selected agent for both scenarios. All OMFSs would prescribe antibiotic prophylaxis for patients with uncontrolled diabetes mellitus in both cases, but only 56.0–63.0% of GDs would do this. GDs based prescribing decisions primarily on information from prescribing guides, while OMFSs relied more on information gained from specialist training. Surgical prophylaxis protocols differed considerably between groups. Both groups used surgical prophylaxis for some situations that are outside current recommendations. Education with regards to discrepancies between clinical practice and current guidelines for antimicrobial therapy is needed to progress antimicrobial stewardship.
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3
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Carasso S, Amy DPB, Kusniec F, Ghanim D, Sudarsky D, Kinany W, Shmuel C, Abu El-Naaj I, Kachel E, Amir O. Dental screening prior to valve interventions: Should we prepare transcatheter aortic valve replacement candidates for "surgery"? Int J Cardiol 2019; 294:23-26. [PMID: 31378381 DOI: 10.1016/j.ijcard.2019.07.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 06/01/2019] [Accepted: 07/25/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND 40% of cases of infective endocarditis (IE) are likely caused by oral bacteria. IE prevalence after transcatheter aortic valve replacement (TAVR) is comparable to IE following surgical prosthetic valve replacement (SVR). Current guidelines recommend pre-operative dental screening for SVR, without specific recommendations regarding TAVR. We aimed to compare oral dental findings in TAVR vs. surgical valve replacement (SVR) candidates and assess the need for routine dental screening and treatment prior to TAVR similar to the SVR patients. METHODS 150 patients (58 TAVR candidates and 92 surgical candidates) were all referred for screening and appropriate treatment before intervention to our Oral medicine team, blinded to the planned interventional type. All patients were scored for oral hygiene and dental findings that required intervention. An oral health score (OHS, general hygiene: 0-good, 1-bad, need for immediate treatment: 0-no, 1-yes, need for future treatment: 0-no, 1-yes) was calculated and compared. Patients were clinically followed for IE for 14 ± 5 months (rage 8-28) post intervention. RESULTS While candidates for SVR were younger than TAVR (66 + 10 vs. 81 ± 6 respectively, P < 0.0001), oral-dental findings were similar. OHS was 1.6 for SVR and 1.7 for TAVR candidates, p = 0.45). Half of patients in either group had findings requiring pre-procedural dental treatment. There were two IE cases during follow-up, one in each group. CONCLUSION Oral health and need for pre-procedural dental treatment were not different among candidates for SVR and TAVR. IE preventive oral-dental care seems to be justified in patients undergoing TAVR initially denied SVR due to prohibitive operative risk.
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Affiliation(s)
- Shemy Carasso
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel.
| | - Dalit Porat Ben Amy
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel; Oral Medicine Unit, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel
| | - Fabio Kusniec
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Diab Ghanim
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Doron Sudarsky
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Wadi Kinany
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Chen Shmuel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel; Oral Medicine Unit, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel
| | - Imad Abu El-Naaj
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel; Oral and Cranio-maxillofacial surgery Department, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel
| | - Erez Kachel
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Offer Amir
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
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4
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Zeng BS, Lin SY, Tu YK, Wu YC, Stubbs B, Liang CS, Yeh TC, Chen TY, Carvalho AF, Lin PY, Lei WT, Hsu CW, Chen YW, Tseng PT, Chen CH. Prevention of Postdental Procedure Bacteremia: A Network Meta-analysis. J Dent Res 2019; 98:1204-1210. [PMID: 31469596 DOI: 10.1177/0022034519870466] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Postdental procedure bacteremia is common and troublesome. The comparative efficacy of multiple prophylactic interventions is unclear. We compared the efficacy of interventions for the prevention of postdental procedure bacteremia. We conducted a review of ClinicalKey, Cochrane CENTRAL, Embase, ProQuest, PubMed, ScienceDirect, Web of Science, and ClinicalTrials.gov from inception to December 4, 2018. Randomized controlled trials that evaluated prophylactic interventions for the prevention of postdental procedure bacteremia were eligible. The primary outcome was the incidence of postdental procedure bacteremia. A total of 24 trials were included with 2,147 participants. Our network meta-analysis demonstrated that intravenous administration of 1,000/200 mg of amoxicillin/clavulanate provided the least incidence of postdental procedure bacteremia among all the prophylactic interventions (odds ratio = 0.03, 95% CI = 0.00 to 0.63) as compared with the placebo/controls. Oral 3 g of amoxicillin had the least incidence of postdental procedure bacteremia among all oral or topical forms of prophylactic interventions (odds ratio = 0.10, 95% CI = 0.02 to 0.44) as compared with the placebo/controls. No serious adverse events, such as anaphylactic shock, mortality, and the development of antibiotic-resistant bacteria, were reported. None of the included subjects were of high risk of infectious endocarditis. Our network meta-analysis demonstrates that intravenous amoxicillin/clavulanate and oral amoxicillin might be the best prophylactic interventions in preventing postdental procedure bacteremia among all the oral/topical forms of interventions for the overall populations.
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Affiliation(s)
- B S Zeng
- Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - S Y Lin
- Department of Dentistry, MacKay Memorial Hospital, Taipei, Taiwan
| | - Y K Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Y C Wu
- Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan
| | - B Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK.,Positive Ageing Research Institute, Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - C S Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - T C Yeh
- Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - T Y Chen
- Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - A F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction & Mental Health (CAMH), Toronto, ON, Canada
| | - P Y Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - W T Lei
- Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - C W Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Y W Chen
- Prospect Clinic for Otorhinolaryngology and Neurology, Kaohsiung City, Taiwan
| | - P T Tseng
- Prospect Clinic for Otorhinolaryngology and Neurology, Kaohsiung City, Taiwan.,WinShine Clinics in Specialty of Psychiatry, Kaohsiung City, Taiwan
| | - C H Chen
- Program in Translational Medicine, National Chung Hsing University, Taichung City, Taiwan.,Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung City, Taiwan.,Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
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5
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Azad A, Modaresi F, Zahed M, Zarei M, Ranjbaran A, Jahrom ZK. Multiplex polymerase chain reaction for detection of bacteremia during dental extraction. ACTA ACUST UNITED AC 2019; 10:e12425. [PMID: 31175710 DOI: 10.1111/jicd.12425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/20/2019] [Accepted: 04/27/2019] [Indexed: 11/29/2022]
Abstract
AIM Incidence of transient bacteremia following dental extractions ranges 30%-70% among adults and 58%-100% in children. This study aims to assess the multiplex polymerase chain reaction (PCR) technique in detection of transient bacteremia during dental extraction. METHODS Twenty volunteers for dental extraction entered the study. Blood samples were taken at baseline and 30 seconds and 15 minutes after extraction. Five types of bacteria were selected, namely Streptococcus mutans, S. salivarius, S. sanguinis, Enterococcus faecalis and Lactobacillus. Blood samples were evaluated by microbial culture and multiplex PCR. RESULTS Blood culture showed rates of 0%, 80% and 25% for bacteremia before, during and after dental extraction, respectively. A significant difference was observed between baseline and during extraction. Using PCR, bacteremia was deemed 20%, 100% and 30% before, during and after extraction, respectively, and a significant difference was witnessed between the baseline and during extraction. The highest incidence was at the 30-second mark after extraction, and the most prevalent type of bacteria was S. mutans. CONCLUSIONS Multiplex PCR can be used to determine bacterial diversity with high accuracy during occurrence of bacteremia. Therefore, in cases where positive blood cultures only indicate the presence of one species, we recommend the use of this method to detect more diverse bacteria types.
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Affiliation(s)
- Azita Azad
- Department of Oral and Maxillofacial Medicine, Oral and Dental Disease Research Center, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzan Modaresi
- Department of Microbiology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.,Department of Advanced Medical Sciences and Technology, Jahrom University of Medical Sciences, Jahrom, Iran.,Central Laboratory Research, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Maryam Zahed
- Department of Oral and Maxillofacial Medicine, Oral and Dental Disease Research Center, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahshid Zarei
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Ranjbaran
- Department of Oral and Maxillofacial Medicine, Oral and Dental Disease Research Center, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Kargar Jahrom
- Zoonoses Research Center, Jahrom University of Medical Sciences, Shiraz, Jahrom
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6
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Association between periodontal pathogens and systemic disease. Biomed J 2019; 42:27-35. [PMID: 30987702 PMCID: PMC6468093 DOI: 10.1016/j.bj.2018.12.001] [Citation(s) in RCA: 370] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 11/22/2018] [Accepted: 12/04/2018] [Indexed: 12/13/2022] Open
Abstract
A growing body of literature suggests that there is a link between periodontitis and systemic diseases. These diseases include cardiovascular disease, gastrointestinal and colorectal cancer, diabetes and insulin resistance, and Alzheimer's disease, as well as respiratory tract infection and adverse pregnancy outcomes. The presence of periodontal pathogens and their metabolic by-products in the mouth may in fact modulate the immune response beyond the oral cavity, thus promoting the development of systemic conditions. A cause-and-effect relationship has not been established yet for most of the diseases, and the mediators of the association are still being identified. A better understanding of the systemic effects of oral microorganisms will contribute to the goal of using the oral cavity to diagnose and possibly treat non-oral systemic disease.
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7
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Saliasi I, Llodra JC, Bravo M, Tramini P, Dussart C, Viennot S, Carrouel F. Effect of a Toothpaste/Mouthwash Containing Carica papaya Leaf Extract on Interdental Gingival Bleeding: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122660. [PMID: 30486374 PMCID: PMC6313435 DOI: 10.3390/ijerph15122660] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/13/2018] [Accepted: 11/23/2018] [Indexed: 12/31/2022]
Abstract
Clinical research on herbal-based dentifrice +/− mouth rinse products is very limited compared with the plethora of research on conventional oral care products under normal oral hygiene conditions. The aim of this study was to determine the anti-inflammatory effects of a novel plant Carica papaya leaf extract (CPLE) on interdental bleeding in healthy subjects. In this randomized, single-blind parallel-design study, the eligible subjects were generally healthy non-smokers, aged 18–26, who exhibited healthy periodontal conditions upon study entry. The participants were equally randomized into the following four groups: CPLE dentifrice, CPLE dentifrice and mouthwash, sodium lauryl sulfate (SLS)-free enzyme-containing dentifrice and SLS-free enzyme-containing dentifrice with essential oil (EO) mouthwash. Subjects were instructed to brush their teeth twice a day without changing their other brushing habits. Interdental bleeding (BOIP) was measured from inclusion (T0) until the fourth week (T4) of the study. Clinical efficacy was assessed after one, two, three and four weeks of home use. The analyses compared BOIP between groups and were then restricted to participants with ≥70% and then ≥80% bleeding sites at T0. Pairwise comparisons between groups were performed at T0 and T4, and a logistic regression identified correlates of gingival bleeding (T4). Among 100 subjects (2273 interdental sites), the median percentage of bleeding sites per participant at T0 was 65%. The bleeding sites dramatically decreased in all groups between T0 and T4 (relative variations from −54% to −75%, p < 0.01 for all). Gingival bleeding did not significantly differ between the CPLE dentifrice and the SLS-free dentifrice +/− EO mouthwash groups (from p = 0.05 to p = 0.86), regardless of the baseline risk level. Among the CPLE dentifrice users, fewer bleeding sites were observed when toothpaste and mouthwash were combined compared to bleeding sites in those who used toothpaste alone (21% vs. 32%, p = 0.04). CPLE dentifrice/mouthwash provides an efficacious and natural alternative to SLS-free dentifrice +/−EO-containing mouthwash when used as an adjunct to mechanical oral care to reduce interdental gingival inflammation.
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Affiliation(s)
- Ina Saliasi
- Laboratory "Systemic Health Care", EA4129, University of Lyon, 69008 Lyon, France.
| | - Juan Carlos Llodra
- Department of Preventive and Community Dentistry, Faculty of Odontology, University of Granada, 18010 Granada, Spain.
| | - Manuel Bravo
- Department of Preventive and Community Dentistry, Faculty of Odontology, University of Granada, 18010 Granada, Spain.
| | - Paul Tramini
- Department of Public Health, Faculty of Dental Medicine, University of Montpellier, 34090 Montpellier, France.
| | - Claude Dussart
- Laboratory "Systemic Health Care", EA4129, University of Lyon, 69008 Lyon, France.
| | - Stéphane Viennot
- Laboratory "Systemic Health Care", EA4129, University of Lyon, 69008 Lyon, France.
| | - Florence Carrouel
- Laboratory "Systemic Health Care", EA4129, University of Lyon, 69008 Lyon, France.
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8
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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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9
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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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10
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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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Cantarelli R, Negrini TC, Muniz FW, Oballe HJ, Arthur RA, Rösing CK. Antimicrobial potential and gustatory perception of chlorhexidine gluconate mouthwashes with or without alcohol after a single rinse - a randomized controlled crossover clinical trial. Int J Dent Hyg 2016; 15:280-286. [DOI: 10.1111/idh.12255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2016] [Indexed: 11/28/2022]
Affiliation(s)
- R Cantarelli
- Post-Graduate Program in Dentistry; Federal University Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
| | - TC Negrini
- Department of Conservative Dentistry; Federal University Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
| | - FW Muniz
- Post-Graduate Program in Dentistry; Federal University Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
| | - HJ Oballe
- Post-Graduate Program in Dentistry; Federal University Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
| | - RA Arthur
- Department of Preventive and Community Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
| | - CK Rösing
- Department of Periodontology; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
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13
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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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14
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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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