Bacteremia following different oral procedures: systematic review and meta-analysis

Objectives: To evaluate the timing, duration and incidence of bacteremia following invasive dental procedures (IDPs) or activities of daily living (ADL). Methods: Eight databases were searched for randomized (RCTs) and non-randomized controlled trials (nRCTs) evaluating bacteremia before and after IDPs or ADL in healthy individuals. The risk of bias was assessed by RoB 2.0 and ROBINS-I. For the meta-analysis, the primary outcomes were the timing and duration of bacteremia. The secondary outcome was the incidence of bacteremia, measuring the proportion of patients with bacteremia within 5 minutes after the end of the procedure compared to baseline. Results: We included 64 nRCTs and 25 RCTs. Peak bacteremia occurred within 5 minutes after the procedure and then decreased over time. Dental extractions showed the highest incidence of bacteremia (62%-66%), followed by scaling and root planing(SRP) (44%-36%) and oral health procedures (OHP) (e.g., dental prophylaxis and dental probing without SRP) (27%-28%). Other ADL (flossing and chewing) (16%) and toothbrushing (8%-26%) resulted in bacteremia as well. The majority of studies had some concerns (RCTs) or moderate risk of bias (nRCTs). Conclusion: Dental extractions, SRP and OHP, are associated with the highest frequency of bacteremia. Toothbrushing, flossing and chewing also caused bacteremia in lower frequency