title: Dissemination of periodontal pathogens in the bloodstream after periodontal procedures: a systematic review.
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.
  
  
  METHODS
  Systematic Review.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil.
authors.forename: Anna Carolina Ratto Tempestini
authors.initials: AC
authors.lastname: Horliana
authors.affiliation: Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil.
authors.forename: Leandro
authors.initials: L
authors.lastname: Chambrone
authors.affiliation: Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil.
authors.forename: Adriana Moura
authors.initials: AM
authors.lastname: Foz
authors.affiliation: Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil.
authors.forename: Hilana Paula Carillo
authors.initials: HP
authors.lastname: Artese
authors.affiliation: Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil.
authors.forename: Mariana de Sousa
authors.initials: Mde S
authors.lastname: Rabelo
authors.affiliation: Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil.
authors.forename: Cláudio Mendes
authors.initials: CM
authors.lastname: Pannuti
authors.affiliation: Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil.
authors.forename: Giuseppe Alexandre
authors.initials: GA
authors.lastname: Romito
mesh_terms: D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology*; D003777:Dental Prophylaxis / Q000009:adverse effects*; D006801:Humans; D064887:Observational Studies as Topic; D010510:Periodontal Diseases / Q000382:microbiology* / Q000517:prevention & control*; D015995:Prevalence; D012107:Research Design