This Article Full Text Full Text (PDF) All Versions of this Article: 117/24/3118    most recent CIRCULATIONAHA.107.758524v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions patientINFORMation Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lockhart, P. B. Articles by Bahrani-Mougeot, F. K. Search for Related Content PubMed PubMed Citation Articles by Lockhart, P. B. Articles by Bahrani-Mougeot, F. K. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB AMOXICILLIN Medline Plus Health Information Dental Health Related Collections Secondary prevention Valvular heart disease Related Article

(Circulation. 2008;117:3118-3125.)
© 2008 American Heart Association, Inc.

Valvular Heart Disease

Bacteremia Associated With Toothbrushing and Dental Extraction

Peter B. Lockhart, DDS; Michael T. Brennan, DDS, MHS; Howell C. Sasser, PhD; Philip C. Fox, DDS; Bruce J. Paster, PhD; Farah K. Bahrani-Mougeot, PhD

From the Department of Oral Medicine (P.B.L., M.T.B., P.C.F., F.K.B.-M.) and Dickson Institute for Health Studies (H.C.S.), Carolinas Medical Center, Charlotte, NC, and The Forsyth Institute (B.J.P.), Boston, Mass.

Correspondence to Dr Peter B. Lockhart, Chair, Department of Oral Medicine, Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232-2861. E-mail Peter.Lockhart{at}carolinashealthcare.org

Received December 4, 2007; accepted March 19, 2008.

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.

---

 

CLINICAL PERSPECTIVE

Find additional patient-related information at:

Read a summary of this article at americanheart.org

Related Article:

Clinical Summaries
Circulation 2008 117: 3055-3056. [Extract] [Full Text]

This article has been cited by other articles:

				P. B. Lockhart, M. T. Brennan, M. Thornhill, B. S. Michalowicz, J. Noll, F. K. Bahrani-Mougeot, and H. C. Sasser Poor oral hygiene as a risk factor for infective endocarditis-related bacteremia J Am Dent Assoc, October 1, 2009; 140(10): 1238 - 1244. [Abstract] [Full Text] [PDF]

				Endorsed by the European Society of Clinical Micro, Authors/Task Force Members, G. Habib, B. Hoen, P. Tornos, F. Thuny, B. Prendergast, I. Vilacosta, P. Moreillon, M. de Jesus Antunes, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): The Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC) Eur. Heart J., October 1, 2009; 30(19): 2369 - 2413. [Full Text] [PDF]

				N. Brooks Prophylactic antibiotic treatment to prevent infective endocarditis: new guidance from the National Institute for Health and Clinical Excellence Heart, May 1, 2009; 95(9): 774 - 780. [Full Text] [PDF]

				E. L. Kaplan Letter by Kaplan Regarding Article, "Bacteremia Associated With Toothbrushing and Dental Extraction" Circulation, January 20, 2009; 119(2): e13 - e13. [Full Text] [PDF]

				P. B. Lockhart, M. T. Brennan, P. C. Fox, F. K. Bahrani-Mougeot, H. C. Sasser, and B. J. Paster Response to Letter by Kaplan Regarding Article, "Bacteremia Associated With Tooth Brushing and Dental Extraction" Circulation, January 20, 2009; 119(2): e14 - e14. [Full Text] [PDF]

				M. L. Barnett JOURNALSCAN J Am Dent Assoc, September 1, 2008; 139(9): 1245 - 1247. [Full Text] [PDF]