Bacteraemia of oral origin in children—A Systematic review and network meta-analysis

Abstract

Objectives: To systematically review the prevalence of bacteraemia, triggered by dental intervention and home oral hygiene practices, in children. The network meta-analysis (NMA) quantitatively compared the risk of bacteraemia triggered by dental extractions and home and professional cleaning procedures. Materials and Methods: Clinical trials with the outcome “bacteraemia in children” were searched. The NMA was performed using the frequentist weighted least-squares approach comparing the odds ratios (OR) of different interventions. Results: Among 11 of 13 studies, dental treatment was performed under general anaesthesia. In 2,381 patients, bacteraemia occurred in 38.7%–56% patients following single-tooth extractions, in 22%–46% after manual toothbrushing (MTB), and in 26%–78% after power toothbrushing (PTB). When MTB was set as the reference (OR 1), rubber cup polishing showed a slightly higher risk (OR 1.26) of bacteraemia. PTB presented a higher risk (OR 1.79–2.27) than with single-tooth extractions (OR 1.55) but lower than that with multiple extractions (OR 2.55). Conclusion: Daily use of MTB and routine professional cleaning were associated with the lowest risk of developing bacteraemia in children with gingivitis, almost as much as with a single-tooth extractions. Improved plaque control with PTB increased the risk of bacteraemia. There is limited evidence on gingivitis-free and systemically-diseased children.