Publication: Klorheksidin glukonat içeren antiseptik gargaranın, ortodontik bantlama ve bant sökümüne bağlı olarak ortaya çıkabilecek bakteriyemi üzerine etkisinin araştırılması
Abstract
Çalışmamızın amacı %0.2'lik klorheksidin glukonat içeren antiseptik ağız gargarasının, ortodontik tedavi gören hastalarda, bantlama ve bant-braket söküm işlemleri sırasında oluşacak olan bakteriyemi prevalansı üzerine etkisinin incelenmesidir. Çalışma iki ayrı hasta grubu üzerinde yürütülmüştür. Bantlama grubu, yaşları 14 ile 24 arasında değişen, 40 hastadan; bant-braket söküm grubu da yaşları 13 ile 27 arasında değişen 40 hastadan oluşmaktadır. Genel sağlık durumu iyi olan, endokardit riski oluşturacak herhangi bir kalp hastalığı bulunmayan, ağız hijyeni iyi olan, son 30 gün içinde antibiyotik kullanmamış olan ve ağız bakımları için düzenli olarak antiseptik ağız gargarası kullanmayan hastalar çalışma gruplarına dahil edilmiştir. Bantlama hastalarında, mesial ve distal yüzeylerinde çürük veya dolgu bulunmayan ve komşu dişlerle kontağı olan en az bir tane üst birinci büyük azı dişinin bulunmasına dikkat edilmiştir. Bant-braket söküm grubunda ise hem alt, hem üst çenede, bütün birinci büyük azı dişlerinde bant ve diğer dişlerinde standart Edgewise braket bulunan hastalar seçilmiştir. Çalışmaya başlamadan önce hastalara plak indeksi ve gingival indeks yapılarak, ağız hijyeni iyi olanlar gruplara dahil edilmiştir. Bantlama hastalarında separasyon işlemi pirinç separatörlerle yapılmıştır. Bantlama ve bant-braket sökümünden önce, bütün hastalardan, antekubital ven bölgesinden, 11 mililitre kan alınmıştır. Daha sonra her iki gruptaki hastalara da %0.2'lik klorheksidin glukonat içeren ağız gargarasıyla, 60 saniye ağızlarını çalkalamaları söylenmiştir. Çalkalama işleminden sonra, 2 dakika içinde, bantların yerleştirilmesi veya bant-braket sökümü tamamlanarak, tekrar 11 mililitre kan alınmıştır. Alınan kanların 10 mililitresi hemokültür şişelerine inoküle edilirken, 1 mililitresi katı besiyerine ekilmek üzere enjektörde bırakılmıştır. Etiketlenmiş olan hemokültür şişelerine, bakteriyemi üremesini belirleyen indikatör bölümü yerleştirilerek iki hafta süreyle üreme olup olmadığı gözlenmiştir. Üreyen bakterilerin tanımı; koloni morfolojisi, Gram boyama yöntemi, aerotolerans, klasik biyokimyasal yöntemler ve API 20 A kitleri ile; bakteri sayımı ise katı besiyerine ekilen 1 ml kanda, koloni oluşturma birimi olarak yapılmıştır. Bantlama grubunda, preoperatif kan örneklerinin hiçbirisinde bakteriyemi görülmemiştir. Postoperatif kan örneklerinde ise %2.5 oranında bakteriyemi tespit edilmiştir. Bant-braket söküm grubunda ise hem preoperatif, hem de postoperatif kan örneklerinde bakteriyemi oranı %2.5 olarak belirlenmiştir. Postoperatif kan örneklerinden alınan sonuçlar, daha önce Marmara Üniversitesi Dişhekimliği Fakültesi Ortodonti Anabilimdalı'nda yürütülen ve benzer gereç ve yöntem kullanılarak yapılan iki farklı çalışmanın sonuçlarıyla karşılaştırılmıştır. İstatistiksel değerlendirmeler bağımsız iki oranın karşılaştırılmasında kullanılan t-testi ile yapılmıştır. Sonuç olarak; çalışmamızda, klorheksidin glukonat içeren ağız gargarası kullanımı sonucu, bantlama ve bant-braket söküm işlemleri sonrası oluşan bakteriyemi prevalansında bir azalma saptanmasına rağmen, klorheksidin kullanmayan gruplarla karşılaştırldığında, istatistiksel olarak anlamlı bir fark bulunmamıştır.
INVESTIGATION OF BACTEREMİA AFTER ORTHODONTIC BANDING AND DEBANDING, FOLLOWING CHLORHEXIDINE GLUCONATE MOUTHWASH APPLICATION The aim of our study was to investigate the prevelance of bacteremia after orthodontic banding and debanding, following the application of a 0.2% chlorhexidine gluconate mouthwash. The study was carried out in two groups of patients. The first group was the banding group which consisted of 40 patients. Ages of the patients ranged from 14 to 24. The second group was the debanding group which consisted of another 40 patients. Ages of the patients ranged from 13 to 27. In the banding group, patients who did not have any decay or restorations on the mesial and distal sides of one of the upper first molars were selected. In the banding group brass separators were used and band selection was done one week before the final fitting session of the bands. In the debanding group, patients who were treated with a multibracket system, with bands on the first molars and directly bonded attachments on the other teeth in both jaws were selected. Another important criterion in the selection of the patients was oral hygiene. Plaque and gingival scores of each patient were recorded before starting the procedures and the ones having a good oral hygiene were included in the study groups.Patient exclusion criteria was as follows: § Having general health problems § Having a risk factor for bacterial endocarditis § Usage of antibiotics within the last 30 days § Usage of any antiseptic mouthwash for daily prophylactic procedures In both groups, before the banding and debanding procedures, 11 ml of blood was withdrawn from an antecubital vein with a strict aseptic technique. Then the patients were asked to rinse their mouth with a 0.2% chlorhexidine gluconate mouthwash for 60 seconds. After rinsing, banding and debanding procedures were completed within 2 minutes and 11 ml of blood was withdrawn again from each patient. While 10 ml of blood was injected aseptically into the hemoculture bottles, 1 ml was left in the syringe to be examined by the pour-plate method in the microbiology laboratory. The labeled bottles were then connected to a growth indicator device, incubated at 370C for two weeks and examined for any bacterial growth. For the positive cultures, the identification of the bacterial colonies were done by colony morphology, gram-staining procedures, standard microbiologic biochemical testing technique and API 20 A strips. The number of bacteria per millilitre of blood was determined by the pour-plate method. In the banding group no preoperative bacteremia and 2.5% postoperative bacteremia was detected. In the debanding group 2.5% bacteremia was detected in both preoperative and postoperative samples. The postoperative bacteremia prevalences found in our study were compared with the findings of two preliminary studies, carried out in the Marmara University, Faculty of Dentistry, Department of Orthodontics, using similar materials and methods, in which bacteremia prevelances had been investigated after banding and debanding procedures without a prior application of chlorhexidine mouthwash. T-test for testing the difference between two independent proportions was used in the statistical analysis of the findings. As a result, although the prevelance of bacteremia decreased after banding and debanding procedures following the application of the chlorhexidine mouthwash, this decrease was not statistically significant.
INVESTIGATION OF BACTEREMİA AFTER ORTHODONTIC BANDING AND DEBANDING, FOLLOWING CHLORHEXIDINE GLUCONATE MOUTHWASH APPLICATION The aim of our study was to investigate the prevelance of bacteremia after orthodontic banding and debanding, following the application of a 0.2% chlorhexidine gluconate mouthwash. The study was carried out in two groups of patients. The first group was the banding group which consisted of 40 patients. Ages of the patients ranged from 14 to 24. The second group was the debanding group which consisted of another 40 patients. Ages of the patients ranged from 13 to 27. In the banding group, patients who did not have any decay or restorations on the mesial and distal sides of one of the upper first molars were selected. In the banding group brass separators were used and band selection was done one week before the final fitting session of the bands. In the debanding group, patients who were treated with a multibracket system, with bands on the first molars and directly bonded attachments on the other teeth in both jaws were selected. Another important criterion in the selection of the patients was oral hygiene. Plaque and gingival scores of each patient were recorded before starting the procedures and the ones having a good oral hygiene were included in the study groups.Patient exclusion criteria was as follows: § Having general health problems § Having a risk factor for bacterial endocarditis § Usage of antibiotics within the last 30 days § Usage of any antiseptic mouthwash for daily prophylactic procedures In both groups, before the banding and debanding procedures, 11 ml of blood was withdrawn from an antecubital vein with a strict aseptic technique. Then the patients were asked to rinse their mouth with a 0.2% chlorhexidine gluconate mouthwash for 60 seconds. After rinsing, banding and debanding procedures were completed within 2 minutes and 11 ml of blood was withdrawn again from each patient. While 10 ml of blood was injected aseptically into the hemoculture bottles, 1 ml was left in the syringe to be examined by the pour-plate method in the microbiology laboratory. The labeled bottles were then connected to a growth indicator device, incubated at 370C for two weeks and examined for any bacterial growth. For the positive cultures, the identification of the bacterial colonies were done by colony morphology, gram-staining procedures, standard microbiologic biochemical testing technique and API 20 A strips. The number of bacteria per millilitre of blood was determined by the pour-plate method. In the banding group no preoperative bacteremia and 2.5% postoperative bacteremia was detected. In the debanding group 2.5% bacteremia was detected in both preoperative and postoperative samples. The postoperative bacteremia prevalences found in our study were compared with the findings of two preliminary studies, carried out in the Marmara University, Faculty of Dentistry, Department of Orthodontics, using similar materials and methods, in which bacteremia prevelances had been investigated after banding and debanding procedures without a prior application of chlorhexidine mouthwash. T-test for testing the difference between two independent proportions was used in the statistical analysis of the findings. As a result, although the prevelance of bacteremia decreased after banding and debanding procedures following the application of the chlorhexidine mouthwash, this decrease was not statistically significant.