CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 6, July 2012
342
AFRICA
brushing. The duration was less than 15 minutes. The organisms
cultured after tooth brushing are listed in Table 4. The number
of patients who had positive blood cultures in the groups with
good, fair and poor plaque and gingival index scores are shown
in Tables 5 and 6.
The frequency of bacteraemia following chewing
There were 32 black patients, 20 males and 12 females, in this
part of the study. Their ages ranged from 16 to 45 years (mean
25). Both the plaque and gingival index scores were rated as
good, fair and poor in 11, 12 and nine volunteers, respectively.
None of the blood cultures taken before, during and following
mastication yielded any bacterial growth. Based on this
preliminary analysis, it was decided to terminate the study. The
target number in this part of the study was 60 patients.
Discussion
There are conflicting data regarding the degree of oral disease
necessary to produce bacteraemia after oral procedures. Okell
and Elliott found that the occurrence and degree of bacteraemia
after dental extraction depended upon the severity of gum
disease,
7
whereas McEntegart and Porterfield found that the
incidence of post-extraction bacteraemia was unrelated to the
extent of oral sepsis.
18
In children, Peterson and Peacock found
that the incidence of bacteraemia following dental extraction
was unrelated to the local disease,
19
while Speck
et al.
found that
bacteraemia was more common after extraction of abscessed
teeth.
20
Cobe reported that the occurrence of periodontal disease
had little effect on the incidence of bacteraemia after tooth
brushing,
21
whereas the data of Sconyers
et al.
suggested that
there was a relationship between the frequency of bacteraemia
after tooth brushing and oral health.
22,23
Cobe also found no
relationship between periodontal disease and the occurrence of
bacteraemia after chewing.
21
Attempts to establish a relationship between bacteraemia and
oral disease from published reports have been extremely difficult.
The first problem relates to terminology. Cooke noted that it was
only in the 1960s that the all-embracing term ‘oral disease’ was
replacing the older and equally vague term ‘oral sepsis’ and that
these had clouded the interpretation of any relationship between
specific oral disease such as gingivitis and periodontitis, and
bacteraemia.
24
Furthermore, terms such as ‘dental sepsis’ and
‘moderate’ and ‘severe gum disease’ were not defined.
The second problem relates to the diversities in the type of
surgical procedures (e.g. single vs multiple dental extractions),
time of blood sampling, volume of blood cultured and the
methods used to isolate and identify the micro-organisms. This
hindered interpretation and comparison of the results.
12
In our study, we were unable to find a relationship between
the plaque and gingival index scores, which are indicators of
oral health status, and bacteraemia following dental extraction.
Bacteraemia occurred after dental extraction in 27.8, 32.4 and
28.6% of black patients with good, fair and poor plaque index
scores, and in 23.7, 35.3 and 30.6% of patients with good, fair
and poor gingival index scores, respectively. These differences
were not statistically significant.
Coulter
et al.
found that there was no relationship between
the incidence or the intensity of post-extraction bacteraemia and
either the amount of plaque around the gingival margin or the
gingival condition in children.
25
Lewis
et al.
reported that there was no correlation between oral
health status and positive blood cultures after dental extraction in
black patients in the abstract of their article.
26
However, in their
discussion they stated that although the majority of their subjects
were considered to have poor oral health, it was not possible to
draw any definite conclusion about the relationship between oral
health and post-extraction bacteraemia. Lockhart
27
and Lockhart
et al.
28
found that the degree or severity of oral disease did not
correlate with the results of blood culture.
In our study, 29.6% of our patients developed bacteraemia
after dental extraction. The frequency of positive blood cultures
after dental extraction ranged from zero to 85% (mean 40%).
8
Using a lysis-filtration technique to process blood samples,
Heimdahl
et al.
observed bacteria in 100% of patients after
dental extraction.
29
Using molecular techniques, Lockhart
et al.
found that the cumulative incidence of infective endocarditis-
related bacteraemia was 60.4%.
28
Lewis
et al.
studied 60 black patients and detected bacteraemia
in 65% of patients after dental extraction.
26
Streptococci
accounted for 35.7% of their positive blood cultures. In our
study, streptococci made up 76.9% of the bacteria isolated. These
data are in keeping with published reports, which indicate that
viridans streptococci are the most frequent micro-organisms
cultured after extraction.
5,12
None of our patients had positive blood cultures at 15 and
30 minutes after extraction. The duration of bacteraemia after
dental extraction is relatively brief, less than 30 minutes.
8
Some
investigators have found blood cultures positive for organisms
further on in time but they drew blood specimens following
surgical procedures of different durations.
27
In our study, tooth brushing produced bacteraemia in 10.8%
of black patients and the duration was less than 15 minutes in
all patients. Bacteraemia was detected in the studies by Cobe
(24.2% positive),
21
Rise
et al.
(26.0% positive),
30
Schlein
et al.
(25% positive),
31
Roberts
et al.
(38.5% positive),
2
Sconyers
et al.
TABLE 4. ORGANISMS CULTUREDAFTER TOOTH BRUSHING
Aerobic cultures
No. Anaerobic cultures
No.
Streptococcus sanguis
Streptococcus salivarius
Viridans streptococci
2
1
2
Streptococcus sanguis
Streptococcus salivarius
Bacillus
species
Corynebacterium
species
2
1
1
1
TABLE 5. PATIENTSWITH POSITIVE CULTURESAFTER
TOOTH BRUSHING IN RELATION TO PLAQUE INDEX*
Plaque index score
No. in group No. positive
% positive
Good
Fair
Poor
24
24
26
2
1
5
8.3
4.2
19.2
*Differences between the groups were not statistically significant
TABLE 6. PATIENTSWITH POSITIVE CULTURESAFTER
TOOTH BRUSHING IN RELATION TO GINGIVAL INDEX*
Gingival index score
No. in group No. positive
% positive
Good
Fair
Poor
24
25
25
2
2
4
8.3
8
16
*Differences between the groups were not statistically significant.
