Effects of chlorhexidine preprocedural rinse on bacteremia in periodontal patients: a randomized clinical trial

Abstract

Objective:Single dose of systemic antibiotics and short-term use of mouthwashes reduce bacteremia. However, the effects of a single dose of preprocedural rinse are still controversial. This study evaluated, in periodontally diseased patients, the effects of a pre-procedural mouth rinse on induced bacteremia.Material and Methods:Systemically healthy individuals with gingivitis (n=27) or periodontitis (n = 27) were randomly allocated through a sealed envelope system to: 0.12% chlorhexidine pre-procedural rinse (13 gingivitis and 13 periodontitis patients) or no rinse before dental scaling (14 gingivitis and 15 periodontitis patients). Periodontal probing depth, clinical attachment level, plaque, and gingival indices were measured and subgingival samples were collected. Blood samples were collected before dental scaling, 2 and 6 minutes after scaling. Total bacterial load and levels of P. gingivalis were determined in oral and blood samples by real-time polymerase chain reaction, while aerobic and anaerobic counts were determined by culture in blood samples. The primary outcome was the antimicrobial effect of the pre-procedural rinse. Data was compared by Mann-Whitney and Signal tests (p<0.05).Results:In all sampling times, polymerase chain reaction revealed higher blood bacterial levels than culture (p<0.0001), while gingivitis patients presented lower bacterial levels in blood than periodontitis patients (p<0.0001). Individuals who experienced bacteremia showed worse mean clinical attachment level (3.4 mm vs. 1.1 mm) and more subgingival bacteria (p<0.005). The pre-procedural rinse did not reduce induced bacteremia.Conclusions:Bacteremia was influenced by periodontal parameters. In periodontally diseased patients, pre-procedural rinsing showed a discrete effect on bacteremia control.

Periodontitis and cardiovascular diseases: Consensus report

“…The risk of bacteremia has been associated with periodontal health status in a systematic review, suggesting a higher risk of bacteremia associated with gingival inflammation (Tomas, Diz, Tobias, Scully, & Donos, ). A recent randomized clinical trial (RCT) concluded that periodontal therapy (by means of scaling and root planing, SRP) induced bacteremia in both gingivitis and periodontitis patients, but the magnitude and frequency were greater among periodontitis patients (Balejo et al, ).…”

Periodontitis and Cardiovascular Diseases. Consensus Report

“…The risk of bacteremia has been associated with periodontal health status in a systematic review, suggesting a higher risk of bacteremia associated with gingival inflammation [127]. A recent randomized clinical trial (RCT) concluded that periodontal therapy (by means of scaling and root planing, SRP) induced bacteremia in both gingivitis and periodontitis patients, but the magnitude and frequency were greater among periodontitis patients [5].…”

Salivary Bacterial Count and its Implications on the Prevalence of Oral Conditions

“…9 Most studies on oral bacterial focused on the number of different species of bacteria present in the oral cavity or tooth surfaces the general report is that the number of oral bacteria is higher in neglected/dirty mouth as well as patients with increased pathogenicity of oral bacterial due to impaired immunity and those with increased plaque and calculus accumulation. [10][11][12] This study, aimed at determining the salivary bacterial count in apparently healthy individuals, showed that the mean bacterial count of apparently healthy Nigerian was 8.41 × 108 + 1.06 × 10 9 per mL of saliva. A progressively increasing salivary bacterial count progressively was also observed as oral hygiene tends towards becoming poor.…”