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Effect of a Chlorhexidine Mouthwash on the Risk of Postextraction Bacteremia

Published online by Cambridge University Press:  02 January 2015

I. Tomás ,
M. Álvarez ,
J. Limeres ,
M. Tomás ,
J. Medina ,
J. L. Otero  and
P. Diz
I. Tomás*
Affiliation:
Departments of Special Needs, Spain
M. Álvarez
Affiliation:
School of Medicine and Dentistry, Santiago de Compostela University, Santiago de Compostela, the Research Laboratory of the Department of Clinical Microbiology, Xeral-Cíes Hospital, Vigo, Spain
J. Limeres
Affiliation:
Departments of Special Needs, Spain
M. Tomás
Affiliation:
Research Laboratory of the Department of Clinical Microbiology, Juan Canalejo Hospital, La Coruña, Spain
J. Medina
Affiliation:
Department of Anaesthesiology, Santiago de Compostela University Hospital, Santiago de Compostela, Spain
J. L. Otero
Affiliation:
Biostatistics, Spain
P. Diz
Affiliation:
Departments of Special Needs, Spain
*
Special Needs Unit, School of Medicine and Dentistry, Santiago de Compostela University, C./ Entrerrios s/n, 15782 Santiago de Compostela, Spain (pdiz@ usees)
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Abstract

Objective.

To investigate the prevalence, duration, and etiology of bacteremia following dental extractions performed after a single administration of Chlorhexidine mouthwash.

Design and Setting.

A randomized, controlled trial performed in a university hospital.

Methods.

A series of 106 patients with mental and behavioral disabilities who underwent dental extractions under general anesthesia were randomly assigned to a control group or Chlorhexidine group. The exclusion criteria applied were use of antibiotics in the previous 3 months, use of oral antiseptics, any type of congenital or acquired immunodeficiency, and disease that predisposes the patient to infections or bleeding. The Chlorhexidine group had 0.2% Chlorhexidine mouthwash administered for 30 seconds before any dental manipulation. Blood samples were collected at baseline, 30 seconds, 15 minutes, and 1 hour after the dental extractions. Subculture and further identification of the isolated bacteria were performed by conventional microbiological techniques.

Results.

The prevalence of bacteremia after dental extraction in the control and Chlorhexidine groups were 96% and 79%, respectively, at 30 seconds (P = .008), 64% and 30% at 15 minutes (P <.001), and 20% and 2% at 1 hour (P = .005). The most frequently identified bacteria were Streptococcus species in both the control and Chlorhexidine groups (64% and 68%, respectively), particularly viridans group streptococci.

Conclusion.

We recommend the routine use of a 0.2% Chlorhexidine mouthwash before dental extractions to reduce the risk of postextraction bacteremia.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 5 , May 2007 , pp. 577 - 582
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1. Macfarlane, TW, Ferguson, MM, Mulgrew, CJ. Post-extraction bacteraemia: role of antiseptics and antibiotics. Br Dent J 1984;156:179–181.Google Scholar
2. Lofthus, JE, Waki, MY, Jolkovsky, DL, et al. Bacteremia following subgingival irrigation and scaling and root planing. J Periodontal 1991;62:602–607.CrossRefGoogle ScholarPubMed
3. Allison, C, Simor, AE, Mock, D, Tenenbaum, HC. Prosol-chlorhexidine irrigation reduces the incidence of bacteremia during ultrasonic scaling with the Cavi-Med: a pilot investigation. J Can Dent Assoc 1993;59:673–682.Google ScholarPubMed
4. Rahn, R, Schneider, S, Diehl, O, Schäfer, V, Shah, PM. Preventing post-treatment bacteremia: comparing topical povidone-iodine and Chlorhexidine. J Am Dent Assoc 1995;126:1145–1148.CrossRefGoogle ScholarPubMed
5. Lockhart, PB. An analysis of bacteremias during dental extractions: a double-blind, placebo-controlled study of Chlorhexidine. Arch Intern Med 1996;156:513–520.Google Scholar
6. Brown, AR, Papasian, CJ, Shultz, P, Theisen, FC, Shultz, RE. Bacteremia and intraoral suture removal: can an antimicrobial rinse help? J Am Dent Assoc 1998;129:1455–1460.Google Scholar
7. Erverdi, N, Acar, A, Isguden, B, Kadir, T. Investigation of bacteremia after orthodontic banding and debanding following Chlorhexidine mouth wash application. Angle Orthod 2001;71:190–194.Google Scholar
8. Dajani, AS, Taubert, KA, Wilson, W, et al. Prevention of bacterial endocarditis: recommendations by the American Heart Association. J Am Med Assoc 1997;128:1142–1151.Google Scholar
9. Horstkotte, D, Follath, F, Gutschik, E, et al, Task Force Members on Infective Endocarditis of the European Society of Cardiology, ESC Committee for Practice Guidelines (CPG) and Document Reviewers. Guidelines on prevention, diagnosis and treatment of infective endocarditis executive summary: the Task Force on Infective Endocarditis of the European Society of Cardiology. Eur Heart J 2004;25:267–276.Google Scholar
10. Dental aspects of endocarditis prophylaxis: new recommendations from a working group of the British Cardiac Society Clinical Practice Committee and Royal College of Physicians Clinical Effectiveness and Evaluation 2004. Available at: http://www.rcseng.ac.uk. Accessed April 4, 2007.Google Scholar
11. Gould, FK, Elliot, TSJ, Foweraker, J, et al. Guidelines for the prevention of endocarditis: report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 2006;57:1035–1042.Google Scholar
12. Greene, JC, Vermillion, Jr. The simplified oral hygiene index. J Am Dent Assoc 1964;68:7–13.Google Scholar
13. Ramfiord, SP. The periodontal disease index (PDI). J Periodontal 1967;38:602–610.CrossRefGoogle Scholar
14. Löe, H, Silness, J. Periodontal diseases in pregnancy: prevalence and severity. Acta Odontol Scand 1963;21:533–555.CrossRefGoogle ScholarPubMed
15. Romero, J, Bouza, E, Loza, E, Planes, A, Rodríguez, A. Procedimientos en Microbiología Clínica 3: Hemocultivos. Madrid, España: Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica; 1993.Google Scholar
16. Ruoff, KL. Miscellaneous catalase-negative, gram-positive cocci: emerging opportunists. J Clin Microbiol 2002;40:1129–1133.Google Scholar
17. Ruoff, KL, Whiley, RA, Beighton, D. Streptococcus spp. In: Murray, PR, Baron, EJ, Pfaller, MA, Tenover, FC, Yolken, RH, eds. Manual of Clinical Microbiology. 7th ed. Washington, DC: American Society for Microbiology, 1999:283–295.Google Scholar
18. Facklam, R. What happened to the streptococci: overview of taxonomic and nomenclature changes. Clin Microbiol Rev 2002;15:613–630.Google Scholar
19. Roberts, GJ, Holzel, HS, Sury, MRJ, Simmons, NA, Gardner, P, Longhurst, P. Dental bacteremia in children. Pediatr Cardiol 1997;18:24–27.Google Scholar
20. Rechmann, P, Seewald, M, Strasburg, M, Nauman, P. Bakteriämie-häufig-keit bei extraktionen. Deutsch Zahnärztl Z 1989;44:622–624.Google Scholar
21. Roberts, GJ, Simmons, NB, Longhurst, P, Hewitt, PB. Bacteraemia following local anaesthetic injections in children. Br Dent J 1998;185:295–298.Google Scholar
22. Lockhart, PB, Brennan, MT, Kent, ML, Norton, HJ, Weinrib, DA. Impact of amoxicillin prophylaxis on the incidence, nature, and duration of bacteremia in children after intubation and dental procedures. Circulation 2004;109:2878–2884.Google Scholar
23. Baltch, AL, Pressman, HL, Hammer, MC, Sutphen, NC, Smith, RP, Shaye-gani, M. Bacteremia following dental extractions in patients with and without penicillin prophylaxis. Am J Med Sci 1982;283:129–140.CrossRefGoogle ScholarPubMed
24. Hall, G, Hedström, SA, Heimdahl, A, Nord, CE. Prophylactic administration of penicillins for endocarditis does not reduce the incidence of postextraction bacteremia. Clin Infect Dis 1993;17:188–194.Google Scholar
25. Bender, IB, Naidorf, IJ, Garvey, GJ. Bacterial endocarditis: a consideration for physician and dentist. J Am Dent Assoc 1984;109:415–420.Google Scholar
26. Segreti, J. Is antibiotic prophylaxis necessary for preventing prosthetic device infection? Infect Dis Clin North Am 1999;13:871–877.Google Scholar
27. Addy, M, Jenkins, S, Newcombe, R. The effect of some Chlorhexidine containing mouthrinses on salivary bacterial counts. J Clin Periodontal 1991;18:90–93.Google Scholar
28. Jenkins, S, Addy, M, Wade, W, Newcombe, R. The magnitude and duration of the effects of some mouthrinse products on salivary bacterial counts. ;Clin Periodontal 1994;21:397–401.Google Scholar
29. Netuschil, L, Reich, E, Brecx, M. Direct measurement of the bactericidal effect of Chlorhexidine on human dental plaque. J Clin Periodontal 1989;16:484–488.Google Scholar
30. König, J, Storcks, V, Kocher, T, Bössmann, K, Plagmann, HC. Antiplaque effect of tempered 0.2% Chlorhexidine rinse: an in vivo study. J Clin Periodontal 2002;29:207–210.Google Scholar
31. Barros, VMR, Ito, IY, Azevedo, RVP, Morello, D, Rosateli, PA. Estudo comparativo da eficiência de três métodos de anti-sepsia intrabucal na re-duçao do número de estreptococos do sulco gengival. Rev Odontol Univ Sāo Paulo 1998;12:201–206.Google Scholar