Clinical Scorecard: Investigating the association between inadequate oral hygiene and mesh-related infections following hernia surgery: a systematic review and recommended best practices

At a Glance

Key Highlights

• No direct studies found linking oral hygiene/health with hernia mesh infections; evidence extrapolated from other implant surgeries.
• Poor oral hygiene can cause transient bacteraemia during dental cleaning, potentially leading to distant implant infections.
• Preoperative dental screening and oral health optimization are common in orthopaedic and cardiac implant surgeries but not yet standard in hernia repair.

Guideline-Based Recommendations

Diagnosis

• Screen patients for dental focal infections including gum disease prior to implant surgeries.
• Consider oral health status as part of prehabilitation before complex abdominal wall repairs.

Management

• Administer perioperative antibiotics in surgeries involving foreign body implants.
• Implement preoperative dental interventions such as cleaning, treatment of infections, and oral hygiene instructions.
• Encourage regular dental reviews to treat caries and mouth infections before and after surgery.

Monitoring & Follow-up

• Monitor for signs of implant infection potentially linked to hematogenous spread from oral sources.
• Follow up on oral health status postoperatively to reduce risk of late implant infections.

Risks

• Transient bacteraemia from poor oral hygiene or dental procedures may seed implant infections.
• Poor oral health may contribute to postoperative or delayed mesh infections and related complications.

Patient & Prescribing Data

Adults undergoing surgeries with permanent synthetic implants, including hernia mesh repair.

Perioperative antibiotics and dental hygiene interventions may reduce implant infection risk; however, direct evidence in hernia mesh patients is lacking.

Clinical Best Practices

• Incorporate oral health assessment and optimization into preoperative evaluation for patients receiving implants.
• Provide patient education on maintaining good oral hygiene before and after surgery.
• Coordinate care with dental professionals for screening and treatment of oral infections pre- and post-implant surgery.
• Use perioperative antibiotics judiciously in implant surgeries to mitigate infection risk.
• Recognize that tooth loss post-hernia repair is likely due to pre-existing oral pathology rather than mesh implantation.

References

• Rayyan web app for systematic reviews