Effect of subgingival irrigation on post-scaling bacteremia in periodontal therapy: Systematic review and meta-analysis.
DOI:
https://doi.org/10.64716/z3pd3576Keywords:
Scaling and Root Planing, Bacteremia, Povidone-Iodine, Chlorhexidine, Periodontal TherapyAbstract
Periodontal procedures such as scaling and root planing may induce transient bacteremia, representing a potential systemic risk, particularly in medically compromised patients. Subgingival irrigation has been proposed as an adjunctive strategy to reduce microbial dissemination; however, its effectiveness remains uncertain. This systematic review and meta-analysis aimed to compare the efficacy of subgingival irrigation versus no irrigation in reducing bacteremia following periodontal therapy. A comprehensive electronic search was conducted in PubMed, Scopus, Cochrane Library, Embase, Web of Science, and BVS up to August 2024, following the PRISMA 2020 guidelines. The protocol was prospectively registered in PROSPERO (CRD42025636563). Randomized clinical trials were included, and the primary outcome was the presence of bacteremia, analyzed using risk ratios (RR) with 95% confidence intervals under a random-effects model. Seven studies comprising 318 participants were included. The pooled analysis showed a non-significant reduction in bacteremia risk in the subgingival irrigation group (RR = 0.65; 95% CI: 0.37–1.13; p = 0.06), with moderate heterogeneity (I² = 41%). Among the evaluated agents, povidone-iodine and azithromycin demonstrated greater reductions in bacteremia. The certainty of evidence was assessed using the GRADE approach and rated as high. Although statistical significance was not reached, a consistent trend suggests that subgingival irrigation, particularly with povidone-iodine, may contribute to reducing bacteremia after periodontal treatment and could be considered in patients at increased systemic risk.
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