Hydrogen peroxide in the form of carbamide peroxide is widely used for tooth whitening (bleaching), both in professionally- and in self-administered products. Adverse effects have become evident. Cervical root resorption is a possible consequence of internal bleaching and is more frequently observed in teeth treated with the thermo-catalytic procedure. Tooth sensitivity is experienced in 15-78% of patients undergoing external tooth bleaching. However, clinical studies addressing other adverse effects are lacking. Direct contact with hydrogen peroxide induces genotoxic effects in bacteria and cultured epithelial cells, but the effect is reduced or totally abolished in the presence of metabolising enzymes. Several carcinogenesis studies, including the hamster cheek pouch model, indicate that hydrogen peroxide (H(2)O(2)) might possibly act as a promoter. Until further clinical research is concluded to address the question of possible carcinogenicity, it is recommended that: tooth-bleaching products using concentrated H(2)O(2) should not be used without gingival protection; that H(2)O(2) containing products should be avoided in patients with damaged or diseased soft tissues. For nightguard vital bleaching, minimal amounts of low dose H(2)O(2) (including in the form of carbamide peroxide) are preferred, thereby avoiding prolonged and concentrated exposures.

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Hydrogen peroxide tooth-whitening (bleaching) products: Review of adverse effects and safety issues

Although the prevalence of postoperative deep wound infection after total joint arthroplasty has decreased over the past few decades, it remains a feared consequence for both surgeons and patients107. Moynihan stated that “every operation in surgery is an experiment in bacteriology.”80 This statement provides remarkable insight into the seemingly variable and unpredictable nature of infection. Often, the specific mechanism and timing of bacterial delivery in a given wound is unknown, and it is usually extremely difficult to prove the exact cause of the infection in an individual situation. Despite improved outcomes of treatment for established deep periprosthetic infection, prevention remains a meaningful objective. The estimated cost of treatment67 of an infection at the site of a total hip or total knee arthroplasty exceeds $50,000.

A thorough appreciation of and respect for the innumerable factors that may contribute to an infection is essential in the development of an over-all approach to prevention. The concept of an interdependent relationship among the triad of bacteria, host, and wound is helpful when considering prevention Fig. 1. Infection depends on the number and virulence of the bacteria introduced into a wound, the host's ability to eliminate these bacteria, and the status or viability of the wound environment. Within this triad, multiple variables can contribute to the deposition of bacteria into the wound, many conditions may impair the patient's ability to eliminate bacteria, and numerous vagaries of the wound milieu can facilitate the infectious process (Table I). Every variable may be influenced by the other variables within the triad. For example, the effect of a foreign body on the absolute number of bacteria required to facilitate the infectious process is well known29.



Venn diagram demonstrating the dependent nature of bacteria, host factors, and wound environment on the development of …

Prevention of deep periprosthetic joint infection.

Clinicians have used numerous strategies to combat wound infections, including topical and systemic administration of antibiotics, and various antiseptic agents such as hypochlorite (bleach) and hydrogen peroxide have been placed on wounds to kill bacteria or inhibit their growth. A commonly used antimicrobial agent is povidone-iodine (Betadine), a complex of iodine, the bactericidal component, with polyvinylpyrrolidone (povidone), a synthetic polymer. The most common commercial form is a 10% solution in water yielding 1% available iodine. Povidone-iodine is available as a surgical scrub or skin cleanser with a detergent base (0.75% available iodine) or in other forms. Decisions regarding choice of wound treatment involve two basic considerations: (1) how safe is the treatment, and (2) how effective is the treatment. The safety of a wound care treatment may be determined by whether the treatment retards the progress of the wound through the stages of healing (inflammatory, proliferative/reepithelializing, and remodeling). The efficacy of a wound care treatment (e.g., povidone-iodine) can be judged in vitro by its ability to kill microorganisms and in vivo by whether it decreases the rate or severity of wound infection. The task of evaluating the choice of povidone-iodine solution for treatment of wounds, especially the chronic wounds most often seen in physical therapy practice, is made complex by two factors. First, although there is a large body of research into various aspects of povidone-iodine use in wound care, the results are not always germane to the types of wound treatment most often provided by physical therapists. The relevance of in vitro studies regarding safety and effectiveness to in vivo use with patients may be limited. Much of the published research on wound healing uses animal wound models; however, the applicability of findings in animal studies to human wounds has been questioned.

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Povidone-Iodine Solution in Wound Treatment

Intra-operative incidental contamination of surgical wounds is not rare. Povidone-iodine solution can be used to disinfect surgical wounds. Although povidone-iodine is a good broad-spectrum disinfecting agent, it has occasionally been reported to have a negative effect on wound healing and bone union. Therefore, its safety in a spinal surgery is unclear. A prospective, single-blinded, randomized study was accordingly conducted to evaluate the safety of povidone-iodine solution in spinal surgeries. Ascertained herein was the effect of wound irrigation with diluted povidone-iodine solution on wound healing, infection rate, fusion status and clinical outcome of spinal surgeries. Materials and methods: From January 2002 to August 2003, 244 consecutive cases undergoing primary instrumented lumbosacral posterolateral fusion due to degenerative spinal disorder with segmental instability had been collected and randomly divided into two groups: the study group (120 cases, 212 fusion levels) and the control group (124 cases, 223 fusion levels). Excluded were those patients with a prior spinal surgery, spinal trauma, malignant tumor, infectious spondylitis, rheumatoid arthritis, ankylosing spondylitis, metabolic bone disease, skeletal immaturity or with an immunosuppressive treatment. In the former group, wounds were irrigated with 0.35% povidone-iodine solution followed by normal saline solution just before the bone-grafting and instrumentation procedure. However, only with normal saline solution in the latter. All the operations were done by the same surgeon with a standard technique. All the patients were treated in the same postoperative fashion as well. Later on, wound healing, infection rate, spinal bone fusion and clinical outcome were evaluated in both groups. Results: A significant improvement of back and leg pain scores, modified Japanese Orthopedic Association function scores (JOA) and ambulatory capacity have been observed in both groups. One hundred and seven patients in the study group and one hundred and nine in the control group achieved solid union. There was no infection in the study group but six deep infections in the control group. Wound dehiscence was noted in one group 1 and two group 2 patients. A subsequent statistical analysis revealed higher infection rate in the control group (P<0.05), but no significant difference in fusion rate, wound healing, improvement of pain score, function score and ambulatory capacity between the two groups. Conclusion: Diluted povidone-iodine solution can be used safely in spinal surgeries, and it will not influence wound healing, bone union and clinical outcome.

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Can povidone-iodine solution be used safely in a spinal surgery?

Objectives:The objective of this study is to compare antimicrobial effect of irrigation with chlorhexidine gluconate (CHG) to saline in an animal model.Methods:This study used a segmental defect rat femur model contaminated with Staphylococcus aureus and treated 6 hours after injury with debridement

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J Lindstrom

Papers

Tissue Injury Caused by Wound. Disinfectants