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      Dissemination of Periodontal Pathogens in the Bloodstream after Periodontal Procedures: A Systematic Review

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          Abstract

          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.

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          Most cited references49

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          Infective endocarditis.

          Yok-Ai Que, Philippe Moreillon (2011)
          Infective endocarditis (IE) is lethal if not aggressively treated with antibiotics alone or in combination with surgery. The epidemiology of this condition has substantially changed over the past four decades, especially in industrialized countries. Once a disease that predominantly affected young adults with previously well-identified valve disease--mostly chronic rheumatic heart disease--IE now tends to affect older patients and new at-risk groups, including intravenous-drug users, patients with intracardiac devices, and patients exposed to healthcare-associated bacteremia. As a result, skin organisms (for example, Staphylococcus spp.) are now reported as the pathogen in these populations more often than oral streptococci, which still prevail in the community and in native-valve IE. Moreover, progress in molecular diagnostics has helped to improve the diagnosis of poorly cultivable pathogens, such as Bartonella spp. and Tropheryma whipplei, which are responsible for blood-culture-negative IE more often than expected. Epidemiological data indicate that IE mostly occurs independently of medico-surgical procedures, and that circumstantial antibiotic prophylaxis is likely to protect only a minute proportion of individuals at risk. Therefore, new strategies to prevent IE--including improvement of dental hygiene, decontamination of carriers of Staphylococcus aureus, vaccination, and, possibly, antiplatelet therapy--must be explored.
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            Predictors of tooth loss during long-term periodontal maintenance: a systematic review of observational studies.

            Daniela Chambrone, L. Chambrone, Débora Lima … (2010)
            To systematically assess the factors influencing tooth loss during long-term periodontal maintenance (PM). CENTRAL, MEDLINE and EMBASE were searched up to and including September 2009. Studies limited to patients with periodontitis who underwent periodontal therapy and followed a maintenance care programme for the at least 5 years were eligible for inclusion in this review. Studies were considered for inclusion if they reported data on tooth loss during PM. The search strategy identified 527 potentially eligible articles, of which 13 retrospective case series were included in this review. The risk of bias assessment evaluated by the Newcastle-Ottawa scale showed that eight studies were considered of medium methodological quality and five of low methodological quality. Of 41,404 teeth present after active periodontal treatment, 3919 were lost during PM. The percentages of tooth loss due to periodontal reasons and of patients who did not experience tooth loss varied from 1.5% to 9.8% and 36.0% to 88.5%. Studies' individual outcomes showed that different patient-related factors (i.e. age and smoking) and tooth-related factors (tooth type and location, and the initial tooth prognosis) were associated with tooth loss during PM. The considerable heterogeneity found among studies did not allow definitive conclusions. Age, smoking and initial tooth prognosis were found to be associated with tooth loss during PM. Overall, patients must be instructed to follow periodic PM and quit smoking (smokers). Prospective cohort studies are required to confirm the possible predictors of tooth loss due to periodontal reasons. The allocation of patients into subgroups according to the type of periodontitis and smoking frequency will allow more accurate evaluations.
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              Dentistry and internal medicine: from the focal infection theory to the periodontal medicine concept.

              Lucio Lo-Russo, Giuseppina Campisi, G Pizzo … (2010)
              During past decades the relationship between dentistry and internal medicine and especially the concept of the so-called focal infection theory have long been a matter of debate. The pathogenesis of focal diseases has been classically attributed to dental pulp pathologies and periapical infections. Nonetheless, in recent years, their role is being dismissed while increasing interest is being devoted to the possible associations between periodontal infection and systemic diseases. In fact, periodontal pathogens and their products, as well as inflammatory mediators produced in periodontal tissues, might enter the bloodstream, causing systemic effects and/or contributing to systemic diseases. On the basis of this mechanism, chronic periodontitis has been suggested as a risk factor for cardiovascular diseases associated with atherosclerosis, bacterial endocarditis, diabetes mellitus, respiratory disease, preterm delivery, rheumatoid arthritis, and, recently, osteoporosis, pancreatic cancer, metabolic syndrome, renal diseases and neurodegenerative diseases such as Alzheimer's disease. Various hypotheses, including common susceptibility, systemic inflammation, direct bacterial infection and cross-reactivity, or molecular mimicry, between bacterial antigens and self-antigens, have been postulated to explain these relationships. In this scenario, the association of periodontal disease with systemic diseases has set the stage for introducing the concept of periodontal medicine. This narrative review summarizes the evolution of focal infection theory up to the current pathophysiology of periodontal disease, and presents an update on the relationships between chronic periodontitis and systemic diseases. Copyright © 2010 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
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                Author and article information

                Contributors
                Michael Glogauer: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2014
                Publication date (Electronic): 28 May 2014
                Volume: 9
                Issue: 5
                Electronic Location Identifier: e98271
                Affiliations
                [1]Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
                University of Toronto, Canada
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Analyzed the data: GAR LC CMP. Contributed reagents/materials/analysis tools: LC CMP. Wrote the paper: ACRTH. Designed the search strategy: LC. Data extraction and record in duplicate: ACRTH HPCA AMF MdSR. Conception and design of the work: LC ACRTH. Acquisition of data: ACRTH HPCA AMF. Analysis and interpretation of data: LC CMP. Drafted the article or revised it critically for important intellectual content: GAR LC CMP. Final approval of the version to be published: GAR LC CMP.

                Article
                Publisher ID: PONE-D-14-09436
                DOI: 10.1371/journal.pone.0098271
                PMC ID: 4037200
                PubMed ID: 24870125
                SO-VID: 58596a9c-b90d-4235-979e-db6dab63c435
                Copyright statement: Copyright @ 2014
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 3 March 2014
                Date accepted : 29 April 2014
                Page count
                Pages: 10
                Funding
                The authors have no support or funding to report.
                Categories
                Subject: Research Article
                Subject: Biology and Life Sciences
                Subject: Microbiology
                Subject: Medical Microbiology
                Subject: Medicine and Health Sciences
                Subject: Infectious Diseases
                Subject: Bacterial Diseases
                Subject: Oral Medicine
                Subject: Dentistry
                Subject: Oral Diseases
                Subject: Oral Health

                ScienceOpen disciplines: Uncategorized
                Data availability:
                ScienceOpen disciplines: Uncategorized

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