Rinsing, Irrigation, and Bacteremia

Periodontal therapy can release bacteria into the bloodstream, potentially causing infective endocarditis in susceptible patients. Since antibiotic premedication can’t prevent all cases of infective endocarditis, other methods of reducing the number of potential microorganisms have been studied. The American Heart Association recommends mouth rinsing, subgingival irrigation, and topical antimicrobials such as povidone-iodine, which will act against both Gram-negative and Gram-positive organisms, spores, fungi, viruses, mycobacteria, and protozoa. The effectiveness of rinsing with povidone-iodine on patients with plaque-induced gingivitis prior to ultrasonic scaling was evaluated on 60 patients in this study; 30 patients rinsed for 2 minutes with 0.9% saline, and 30 rinsed with 7.5% povidone-iodine prior to scaling. Blood samples were evaluated before scaling, 30 seconds after, and again at 2 minutes after scaling. The study found that 33% of the saline group and 10% of the povidone-iodine group exhibited bacteremia. Postscaling of 30 seconds, 4 of the saline group and one of the povidone group had circulating oral bacteria. At 2 minutes after scaling, 9 of the saline group and 2 of the povidone group had circulating microorganisms. Results indicated that rinsing with povidone-iodine was 80% more effective than rinsing with saline solution. More importantly, there were no Viridans streptococci in the povidone-iodine group. 

For patients with periodontitis, rinsing is not enough. Pocket depths prevent penetration of the rinse. Patients at high risk for infective endocarditis should still receive antibiotic premedication.