title: Post-tooth extraction bacteraemia: a randomized clinical trial on the efficacy of chlorhexidine prophylaxis.
abstract: OBJECTIVE
  To investigate the development of post-extraction bacteraemia (PEB) after the prophylactic use of chlorhexidine (CHX).
  
  
  METHODS
  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.
  
  
  RESULTS
  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%).
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT02150031.
authors.affiliation: School of Dentistry, Instituto Superior de Ciências da Saúde-Norte, Centro de Investigação de Ciências da Saúde, Gandra, Portugal.
authors.forename: Mario
authors.initials: M
authors.lastname: Barbosa
authors.affiliation: Oral Sciences Research Group, Special Needs Unit, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Prada-López
authors.affiliation: Department of Microbiology, CHUVI, Xeral-Cíes Hospital, IBIV, Vigo, Spain.
authors.forename: Maximiliano
authors.initials: M
authors.lastname: Álvarez
authors.affiliation: Department of Stomatology and Maxilo-Facial Surgery, St. António General Hospital, Oporto, Portugal.
authors.forename: Barbas
authors.initials: B
authors.lastname: Amaral
authors.affiliation: Oral Sciences Research Group, Special Needs Unit, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain.
authors.forename: Casares-De-Cal María
authors.initials: CD
authors.lastname: de los Angeles
authors.affiliation: Oral Sciences Research Group, Special Needs Unit, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Tomás
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control*; D001800:Blood Specimen Collection; D016022:Case-Control Studies; D002710:Chlorhexidine / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009067:Mouthwashes / Q000627:therapeutic use; D015995:Prevalence; D014081:Tooth Extraction / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D009067:Mouthwashes; D002710:Chlorhexidine