The role of dental assessment in source identification during Staphylococcus aureus bacteremia: a scoping review

Staphylococcus aureus bacteremia (SAB) is a severe bloodstream infection associated with substantial morbidity, mortality, and metastatic complications. Early source identification is essential for antimicrobial therapy, source control, treatment duration, and prevention of recurrence. However, the role of oral and dental sources in SAB remains insufficiently defined. This scoping review mapped clinical and microbiological evidence on oral and dental sources, oral Staphylococcus aureus reservoirs, and source attribution in SAB, sepsis, and infective endocarditis.

A scoping review was conducted in accordance with the Population-Concept-Context framework and guided by PRISMA-ScR. PubMed/MEDLINE and Web of Science were searched for terms related to Staphylococcus aureus, bacteremia, bloodstream infection, sepsis, infective endocarditis, dental assessment, odontogenic infection, and oral colonization. Eligible sources included clinical studies, microbiological studies using human oral or dental samples, cohort studies, case reports, and case series addressing oral, dental, odontogenic, or orofacial relevance to S. aureus-related systemic infection. Data were charted according to study characteristics, oral/dental relevance, S. aureus relevance, contribution to source identification, and clinical implications.

Twenty-seven sources were included. Direct evidence mainly consisted of case reports describing severe MRSA or MSSA infections in which dental, oral, or orofacial foci were considered possible or probable sources. Endocarditis-related studies provided contextual evidence on dental procedures, oral screening, and dental status, but were rarely S. aureus-specific. Microbiological studies supported the oral cavity as a potential reservoir for S. aureus, MRSA, and resistant or virulent strains. Procedure-associated and high-risk host studies suggested possible links between oral procedures, mucosal disruption, odontogenic or oro-maxillofacial infection, and bacteremia or sepsis, although direct SAB source attribution remained limited.

Current evidence does not support routine dental assessment for source identification in all patients with SAB. However, targeted dental evaluation may be clinically justified in selected situations, including persistent or unexplained bacteremia, suspected infective endocarditis, severe oral symptoms, odontogenic infection, salivary-gland infection, immunosuppression, or planned cardiac intervention. Future studies should use standardized dental assessment protocols and microbiological comparison of oral and bloodstream isolates to distinguish incidental oral pathology from true source attribution.