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The impact of oral disease and nonsurgical treatment on bacteremia in children

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ABSTRACT

Background

The authors examine the role of dental disease and nonsurgical dental procedures in the incidence and duration of bacteremia in children.

Methods

The authors randomized a group of children to receive amoxicillin or a placebo before dental rehabilitation in an operating room setting. They collected eight blood draws at the following times: two minutes after intubation (draw 1); after dental restorations, pulp therapy and cleaning (draw 2); 10 minutes later (draw 3); and five draws during and after dental extractions (draws 4–8). The authors compared dental disease parameters and the type of dental procedures performed with the incidence and duration of bacteremia.

Results

The authors enrolled 100 children (aged 1–8 years) in the study. The incidence of bacteremia from draw 2 was 20 percent in the placebo group and 6 percent in the amoxicillin group (P = .07), and the incidence from draw 3 was 16 percent in the placebo group and zero percent in the amoxicillin group (P = .03). Subjects with higher gingival scores were more likely to have a bacteremia for draw 2 (P = .01). The authors found that subjects in the group with bacteremia for draw 3 had undergone more pulpotomies than did subjects in the group without bacteremia for draw 3 (3 ± 2.5 standard deviation [SD] versus 1.5 ± 1.6 SD, P = .04), while they found almost no differences for draw 2.

Conclusions

This study suggests that gingival disease has an impact on bacteremia after dental restorations and prophylaxis. Although antibiotics have an impact, they do not eliminate bacteremia altogether.

Section snippets

SUBJECTS, MATERIALS AND METHODS

We enrolled 100 children who required dental treatment in an OR setting owing to uncooperative behavior, young age or the extent of treatment needs. We obtained consent from each child's parent or legal guardian as approved by the institutional review board at Carolinas Medical Center, Charlotte, N.C. We randomized the subjects using a computer-generated random number scheme, and used identical-appearing syringes to administer the placebo or the amoxicillin. All of the investigators were

RESULTS

We enrolled 100 children (age range, 1–8 years) in the study. We randomized the subjects to receive a placebo (51) or amoxicillin (49). We did not collect draw 2 from one subject, and we did not collect draw 3 from six subjects. We dropped these subjects from the data analyses.

The incidence of bacteremia from draw 2 was 20 percent in the placebo group and 6 percent in the amoxicillin group (P = .07). The incidence of bacteremia from draw 3 was 16 percent in the placebo group and zero percent in

DISCUSSION

A variety of dental procedures have been associated with bacteremia in children, but few studies have assessed bacteremia after nonsurgical procedures. Incidence rates after oral prophylaxis in children range from 0 to 40 percent,15, 17, 18 while studies in adults have shown incidence rates of 15 to 61 percent.21, 22 Minimal information is available for incidence rates associated with other types of dental procedures in children. One study reported a higher incidence of bacteremia with rubber

CONCLUSIONS

Few studies have addressed the role of dental disease and dental procedures in children. Our study suggests that gingival disease has an effect on bacteremia after dental restorations and prophylaxis. Although antibiotics have an impact, they do not eliminate bacteremia.

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    The authors would like to acknowledge Drs. Margaret Lochary, Kelly Zukaitis and Carlton V. Winter for their participation in this study. In addition, the authors thank David Weinrib, MD, and David Rupar, MD, for their help with the microbiology data, and William T. Williams, MD, for his instrumental and longstanding support of this effort.

    1

    Dr. Brennan is the oral medicine residency director, Department of Oral Medicine, Carolinas Medical Center, P.O. Box 32861, Charlotte, N.C. 28232

    2

    Ms. Kent is the clinical coordinator, Department of Oral Medicine, Carolinas Medical Center, Charlotte, N.C.

    3

    Dr. Fox is the clinical research director, Department of Oral Medicine, Carolinas Medical Center, Charlotte, N.C.

    4

    Dr. Norton is the director of biostatistics, Department of Biostatistics, Carolinas Medical Center, Charlotte, N.C.

    5

    Dr. Lockhart is chairman, Department of Oral Medicine, Carolinas Medical Center, Charlotte, N.C.

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