Reduction of potential respiratory pathogens by oral hygienic treatment in patients undergoing endotracheal anesthesia.
OBJECTIVE
This study was conducted to evaluate the usefulness of mechanical and chemical prophylactic oral cleansing treatments for reducing potential respiratory pathogens existing in the oral cavity.


METHODS
Thirty-two patients scheduled to undergo oral and maxillofacial surgery that required endotracheal anesthesia were randomly allocated to one of the two groups, the oral cleansing group (n = 16) or the noncleansing group (n = 16). Culture and polymerase chain reaction (PCR) methods were used to detect and enumerate pathogens. Oral cleansing was carried out with an electric toothbrush capable of automatically supplying and aspirating povidone-iodine solution before surgery, followed by rinsing twice a day after surgery. Cephazolin (3 g x day(-1)) was given to all patients for 5 days after surgery.


RESULTS
The PCR detection rates of Streptococcus pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa, and Porphyromonas gingivalis in gargle samples before treatment were 87.5%, 68.8%, 53.1%, and 40.6%, respectively. Oral cleansing reduced the detection rates and numbers of methicillin-sensitive Staphylococcus species, S. pneumoniae, and H. influenzae. In contrast, there was no significant reduction of methicillin-resistant Staphylococcus species, S. pneumoniae, H. influenzae, or P. aeruginosa in subjects who underwent systemic cephazolin administration without oral cleansing.


CONCLUSIONS
The combination of mechanical and chemical oral cleansing resulted in a significant reduction of potential respiratory pathogens in the oral cavity.
Okuda
Minori
M
Oral Health Science Center and Department of Dental Anesthesiology, Tokyo Dental College, 1-2-2 Masago, Chiba 261-8502, Japan.
Kaneko
Yuzuru
Y
Ichinohe
Tatsuya
T
Ishihara
Kazuyuki
K
Okuda
Katsuji
K
D000328:Adult; D000758:Anesthesia; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D015169:Colony Count, Microbial; D006801:Humans; D007442:Intubation, Intratracheal; D008875:Middle Aged; D009055:Mouth / Q000382:microbiology*; D009067:Mouthwashes; D009910:Oral Hygiene; D011182:Postoperative Care; D011206:Povidone-Iodine / Q000008:administration & dosage; D011300:Preoperative Care; D012141:Respiratory Tract Infections / Q000517:prevention & control*; D013515:Surgery, Oral; D014099:Toothbrushing
D000891:Anti-Infective Agents, Local; D009067:Mouthwashes; D011206:Povidone-Iodine