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Infection Control

Frequently Asked Questions - Preprocedural Mouth Rinse

Are preprocedural mouth rinses recommended to reduce contamination from aerosols and spatter?

Antimicrobial mouth rinses used by patients before a dental procedure are intended to reduce the number of microorganisms released by a patient in the form of aerosols or spatter that subsequently can contaminate equipment, operatory surfaces, and dental health care personnel.

No scientific evidence indicates that preprocedural mouth rinsing prevents clinical infections among patient or dental health care personnel. However, studies have shown that a preprocedural rinse with a product containing an antimicrobial product (e.g., chlorhexidine gluconate, essential oils, povidone iodine) can reduce the level of oral microorganisms generated in aerosols or spatter during routine dental procedures with rotary instruments (e.g., dental handpieces, ultrasonic scalers). Preprocedural mouth rinses can be most beneficial before procedures (e.g., prophylaxis cup or ultrasonic scaling) where a rubber dam cannot be used to minimize aerosol and spatter.

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Is a preprocedural mouth rinse recommended to reduce dental procedure-induced bacteremia?

Antimicrobial mouth rinses used by the patient before a dental procedure can decrease the number of microorganisms introduced into the patient's bloodstream during invasive dental procedures. The scientific evidence is not clear, however, concerning the incidence and nature of bacteremia from invasive dental procedures, the relationship of bacteremia to disease, and the preventive benefit of antimicrobial rinses. Limited studies have not shown mouth rinsing to reduce substantially the numbers of oral microorganisms in patients' blood. However, the American Heart Association (1997) suggests that patients at risk for bacterial endocarditis use an antimicrobial mouth rinse before dental treatment. Further study is needed to determine the effectiveness of preprocedural mouth rinsing for reducing dental procedure-induced bacteremia and the relationship of bacteremia to disease.

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Recommendation for preprocedural mouth rinses

CDC makes no recommendation regarding the use of preprocedural antimicrobial mouth rinses to prevent clinical infections among dental health care personnel or patients.

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Selected References and Additional Resources

Brown AR, Papasian CJ, Shultz P, Theisen FC, Shultz RE. Bacteremia and intraoral suture removal: can an antimicrobial rinse help? J Am Dent Assn 1998;129:1455–1461.

Cochran MA, Miller CH, Sheldrake MA. The efficacy of the rubber dam as a barrier to the spread of microorganisms during dental treatment. J Am Dent Assn 1989;119:141–144.

Dajani AS, Bisno AL, Chung KJ, Durack DT, Freed M, Gerber MA, Karchmer AW et al. Prevention of bacterial endocarditis: Recommendations by the American Heart Association. J Am Med Assn 1990;264:2919–2922.

Dajani AS, Taubert KA, Wilson W, Bolger AF, Bayer A, Ferrieri P et al. Prevention of bacterial endocarditis: Recommendations by the American Heart Association. J Am Med Assn 1997;277(22):1794–1801.

Fine DH, Furgang D, Korik I, et al. Reduction of viable bacteria in dental aerosols by preprocedural rinsing with an antiseptic mouthrinse. Am J Dent 1993;6:219–221.

Fine DS, Mendieta C, Barnett ML et al. Efficacy of preprocedural rinsing with an antiseptic in reducing viable bacteria in dental aerosols. J Periodontol 1992;63:821–824.

Fine DS, Yip J, Furgang D, Barnett ML, Olshan AM, Vincent J. Reducing bacteria in dental aerosols: pre-procedural use of an antiseptic mouth rinse. J Am Dent Assn 1993;124:56–58.

Guidelines for Infection Control in Dental Health-Care Settings, 2003. MMWR, December 19, 2003:52(RR-17);1–61.

Klyn SL, Cummings DE, Richardson BW, Davis RD. Reduction of bacteria-containing spray produced during ultrasonic scaling. Gen Dent 2001;49:648–652.

Litsky BY, Mascis JD, Litsky W. Use of an antimicrobial mouthwash to minimize the bacterial aerosol contamination generated by the high-speed drill. Oral Surg Oral Med Oral Pathol 1970;29:25–30.

Lockhart PB. An analysis of bacteremias during dental extractions. A double-blind, placebo-controlled study of chlorhexidine. Arch Intern Med 1996;156:513–520.

Logothetis DD, Martinez-Welles JM. Reducing bacterial aerosol contamination with a chlorhexidine gluconate pre-rinse. J Am Dent Assn 1995;126:1634–1639.

Miller CH and Palenik DJ. Aseptic Techniques. In: Miller CH, Palenik DJ, eds. Infection Control and Management of Hazardous Materials for the Dental Team, 4th ed. St. Louis: Mosby, 2010;201–6.

Mohammed CI, Monserrate V. Preoperative oral rinsing as a means of reducing air contamination during use of air turbine handpieces. Oral Surg 1970;29:291–294.

Muir KF, Ross PW, MacPhee IT, Holbrook WP, Kowolik MJ. Reduction of microbial contamination from ultrasonic scalers. Br Dent J 1978;145:76–78.

Nishimura RA, Carabello BA, Faxon DP, et al. ACC/AHA 2008 guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [PDF–496K]. Circulation 2008;118:887–896.

Pallasch TJ, Slots J. Antibiotic prophylaxis and the medically compromised patient. Periodontol 2000 1996;10:107–138.

Wyler D, Miller RL, Micik RE. Efficacy of self-administered preoperative oral hygiene procedures in reducing the concentration of bacteria in aerosols generated during dental procedures. J Dent Res 1971;50:509.

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