Efficacy of Preoperative Decontamination of the Oral Cavity

Learning Objectives: After studying this article, the participant should be able to: 1. Describe the current controversy surrounding the use of a preoperative intraoral preparation. 2. Provide a rationale for the use of a preoperative prophylactic regimen for decontaminating the oral cavity. 3. Describe the benefits of an intraoral preparation over intravenous antibiotic prophylaxis. This two-part study consisted of: (1) a survey to assess current practice patterns, and (2) an experiment designed to assess the results of varying intraoral preparations. A 48 percent response rate was obtained from the survey of the 318 active members of the American Society of Maxillofacial Surgeons. This survey demonstrated that significant controversy continues regarding the efficacy of preoperative decontamination of the oral cavity. This prospective, randomized experimental study of 30 patients (saline, 10; povidone-iodine, 10; no preparation, 10) demonstrates a significant and sustained reduction of both anaerobic and aerobic bacteria after intraoral preparation with povidone-iodine solution but not saline. The patient's age, use of preoperative intravenous cephalosporin, and type and length of procedure did not influence the postoperative bacterial counts. Although none of the patients in this study developed an infection, recommendations are provided for standardized preoperative treatment of the oral cavity. (Plast. Reconstr. Surg. 106: 895, 2000.)