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Randomized Controlled Trial
. 2008 Jun 17;117(24):3118-25.
doi: 10.1161/CIRCULATIONAHA.107.758524. Epub 2008 Jun 9.

Bacteremia associated with toothbrushing and dental extraction

Peter B Lockhart  1 , Michael T Brennan, Howell C Sasser, Philip C Fox, Bruce J Paster, Farah K Bahrani-Mougeot
Affiliations
Randomized Controlled Trial

Bacteremia associated with toothbrushing and dental extraction

Peter B Lockhart et al. Circulation. .

Abstract

Background: Antibiotic prophylaxis recommendations for the prevention of infective endocarditis are based in part on studies of bacteremia from dental procedures, but toothbrushing may pose a greater threat. The purpose of this study was to compare the incidence, duration, nature, and magnitude of endocarditis-related bacteremia from single-tooth extraction and toothbrushing and to determine the impact of amoxicillin prophylaxis on single-tooth extraction.

Methods and results: In this double-blind, placebo-controlled study, 290 subjects were randomized to (1) toothbrushing, (2) single-tooth extraction with amoxicillin prophylaxis, or (3) single-tooth extraction with identical placebo. Blood was drawn for bacterial culturing and identification at 6 time points before, during, and after these interventions. The focus of our analysis was on bacterial species reported to cause infective endocarditis. We identified 98 bacterial species, 32 of which are reported to cause endocarditis. Cumulative incidence of endocarditis-related bacteria from all 6 blood draws was 23%, 33%, and 60% for the toothbrushing, extraction-amoxicillin, and extraction-placebo groups, respectively (P<0.0001). Significant differences were identified among the 3 groups at draws 2, 3, 4, and 5 (all P<0.05). Amoxicillin resulted in a significant decrease in positive cultures (P<0.0001).

Conclusions: Although amoxicillin has a significant impact on bacteremia resulting from a single-tooth extraction, given the greater frequency for oral hygiene, toothbrushing may be a greater threat for individuals at risk for infective endocarditis.

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Conflict of interest statement

Conflict of Interest Disclosures: None.

Figures

Figure 1
Figure 1. Study Protocol Time Line
The timing for the steps in the brushing and extraction procedures was strictly controlled. The extraction began with 5-7 seconds of tissue reflection followed by 8-10 seconds of tooth elevation, followed by removal in the usual manner.
Figure 2
Figure 2. Study Groups and Reasons for Exclusion
Figure 3
Figure 3. Incidence and Duration of Bacteremia at Six Time Points from Infective Endocarditis-Related Bacterial Species
Numbers at the baseline represent the time points for the 6 blood draws: 1) baseline; 2) 1.5 min. and 3) 5 min. following initiation of brushing or extraction; and 4) 20 min., 5) 40 min., and 6) 60 min. following completion of the brushing or extraction.
See this image and copyright information in PMC

Comment in

References

    1. Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, Cabell CH, Takahashi M, Baltimore RS, Newburger JW, Strom BL, Tani LY, Gerber M, Bonow RO, Pallasch TJ, Shulman ST, Rowley AH, Burns JC, Ferrieri P, Gardner T, Goff D, Durack DT. Prevention of infective endocarditis. Guidelines from the American Heart Association. A guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007;116:1736–1754. - PubMed
    1. Lockhart PB, Schmidtke MA. Antibiotic considerations in medically compromised patients. Dent Clin North Am. 1994;38:381–402. - PubMed
    1. van der Meer JTM, van Wijk W, Thompson J, Vandenbroucke JP, Valkenburg HA, Michel MF. Efficacy of antibiotic prophylaxis for prevention of native-valve endocarditis. Lancet. 1992;339:135–139. - PubMed
    1. Imperiale TF, Horwitz RI. Does prophylaxis prevent postdental infective endocarditis? A controlled evaluation of protective efficacy. Am J Med. 1990;88:131–136. - PubMed
    1. Hall G, Hedström SA, Heimdahl A, Nord CE. Prophylactic administration of penicillins for endocarditis does not reduce the incidence of postextraction bacteremia. Clin Infect Dis. 1993;17:188–194. - PubMed

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