Oral Hygiene and Mesh-Related Infections Post Hernia Surgery: Systematic Review

Overview

This systematic review found no direct evidence linking poor oral hygiene or oral health to mesh-related infections following hernia surgery. However, studies in other surgical fields involving permanent implants suggest that poor oral hygiene may contribute to hematogenous infections. The review highlights a gap in research specifically addressing oral health in hernia mesh surgery patients.

Background

Perioperative antibiotics are standard practice in surgeries involving implants to prevent infection. Other surgical specialties, such as orthopaedics and cardiac surgery, routinely screen for dental infections due to the risk of transient bacteraemia from poor oral hygiene. Despite increasing prehabilitation efforts before complex abdominal wall repairs, oral hygiene has not been considered as a factor in hernia mesh surgery. There is concern that poor oral health may cause bacteraemia leading to mesh infections either perioperatively or long after surgery.

Data Highlights

The systematic review identified 586 papers, with 14 studies included for final analysis encompassing 47,486 patients. No studies directly addressed oral hygiene and mesh infection in hernia surgery. Included studies focused on oral hygiene interventions before or after implant surgeries in other specialties, reporting on implant infection or distant surgical site infections potentially linked to oral health status.

Key Findings

• No published studies directly investigate the association between oral hygiene/health and mesh infections following hernia repair.
• Evidence from other surgical fields suggests that poor oral hygiene can cause transient bacteraemia, potentially leading to implant infections.
• Patients with poor oral health undergoing implant surgery may benefit from dental screening and interventions to reduce infection risk.
• Preoperative dental care and perioperative mouth hygiene are common practices in orthopaedic and cardiac implant surgeries but are not yet standard in hernia mesh repair.
• Legal cases have reported patients experiencing mesh infections and tooth loss, though tooth loss is attributed to ongoing dental pathology rather than mesh surgery itself.
• The quality of evidence is limited, and no statistical meta-analysis was performed due to heterogeneity and lack of direct data.

Clinical Implications

Clinicians should consider the potential role of oral hygiene in preventing implant-related infections and incorporate dental assessment into preoperative evaluation for patients undergoing surgeries with permanent implants, including hernia mesh repair. While direct evidence is lacking, adopting best practices from other surgical specialties may reduce postoperative infection risks. Further research is needed to clarify the impact of oral health on mesh-related infections.

Conclusion

Current evidence does not establish a direct link between poor oral hygiene and mesh infections after hernia surgery, but findings from other implant surgeries suggest a plausible association. Integrating oral health optimization into preoperative care protocols may improve surgical outcomes and reduce infection rates.

References

1. Berg et al. 2023 -- Investigating the association between inadequate oral hygiene and mesh-related infections following hernia surgery: a systematic review and recommended best practices