Barbosa Mario, Prada-López Isabel, Álvarez Maximiliano, Amaral Barbas, de los Angeles Casares-De-Cal María, Tomás Inmaculada
School of Dentistry, Instituto Superior de Ciências da Saúde-Norte, Centro de Investigação de Ciências da Saúde, Gandra, Portugal.
Oral Sciences Research Group, Special Needs Unit, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain.
PLoS One. 2015 May 8;10(5):e0124249. doi: 10.1371/journal.pone.0124249. eCollection 2015.
To investigate the development of post-extraction bacteraemia (PEB) after the prophylactic use of chlorhexidine (CHX).
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.
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%).
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.
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.
Clinicaltrials.gov NCT02150031.
研究预防性使用氯己定（CHX）后拔牙后菌血症（PEB）的发生情况。
共有201例接受拔牙的患者被随机分为四组：52例未进行预防措施（对照组），50例在拔牙前用0.2% CHX进行漱口（CHX-MW组），51例用0.2% CHX进行漱口并使用1% CHX进行龈下冲洗（CHX-MW/SUB_IR组），48例用0.2% CHX进行漱口并使用1% CHX进行持续龈上冲洗（CHX-MW/SUPRA_IR组）。在基线、进行漱口及龈下或龈上冲洗后30秒、拔牙完成后30秒和15分钟采集外周静脉血样本。对血样进行需氧和厌氧条件下的常规微生物培养，对分离株进行细菌鉴定。
对照组、CHX-MW组、CHX-MW/SUB_IR组和CHX-MW/SUPRA_IR组在30秒时PEB的发生率分别为52%、50%、55%和50%，在15分钟时分别为23%、4%、10%和27%。对照组在15分钟时PEB的发生率显著高于CHX-MW组（23%对4%；p = 0.005）。同时，对照组与CHX-MW/SUB_IR组或CHX-MW/SUPRA_IR组之间未发现差异。链球菌（主要是草绿色链球菌）是最常鉴定出的细菌（69 - 79%）。
使用0.2% CHX漱口可显著缩短PEB的持续时间。用1% CHX进行龈下冲洗并未提高漱口的效果，而龈上冲洗甚至降低了这种效果，这可能是由于这些操作对菌血症发生的影响。
这些结果证实了拔牙前用0.2% CHX漱口以缩短PEB持续时间的适用性。这种做法或许应扩展至所有牙科操作。
Clinicaltrials.gov NCT02150031。
