ABSTRACT
BACKGROUND: Infective endocarditis can occur in susceptible individuals due to bacteremia of oral origin. The aim of this study was to investigate the occurrence of bacteremia caused by full mouth periodontal probing. METHODS: Forty patients, 20 with adult periodontitis (10 males, 10 females; mean age 43.0 years) and 20 with chronic gingivitis (11 males, 9 females; mean age 35.5 years) were investigated. Prior to and immediately following periodontal probing, 20 mL of venous blood were obtained from each patient and inoculated into aerobic and anaerobic blood culture bottles and incubated. Negative bottles were monitored continuously for 3 weeks before being discarded. Bottles which signalled positive were subcultured and isolates identified to genus level. Periodontal probing consisted of measuring pockets at 6 points around each tooth and recording the presence or absence of bleeding. A plaque index (PI) was assessed on the 6 Ramfjord teeth. RESULTS: Probing caused bacteremia of oral origin in 8 (40%) of the periodontitis patients and 2 (10%) of the gingivitis patients. Streptococcus spp. were the most common isolates in both groups. Compared with the gingivitis group the odds ratio (OR) for bacteremia in the periodontitis group was 5.993 (95% CI 1.081 to 33.215). Bleeding on probing (OR 1.025, 95% CI 1.004 to 1.047) and mean probing depth per tooth (OR 1.444, 95% CI 1.055 to 1.977) were significantly associated with bacteremia. No significant correlations were found between bacteremia and age, number of teeth probed, smoking status, PI, or total probing depth. CONCLUSIONS: Patients with untreated adult periodontitis are at greater risk of bacteremia due to periodontal probing than patients with chronic gingivitis. For individuals at risk of infective endocarditis, radiographic assessment prior to periodontal probing would be advisable to identify those with periodontitis so that appropriate antibiotic prophylaxis can be provided.
Subject(s)
Bacteremia/etiology , Gingivitis/classification , Periodontics/instrumentation , Periodontitis/classification , Adult , Alveolar Bone Loss/classification , Alveolar Bone Loss/microbiology , Bacteremia/microbiology , Chi-Square Distribution , Chronic Disease , Confidence Intervals , Dental Plaque Index , Female , Gingival Hemorrhage/classification , Gingival Hemorrhage/microbiology , Gingivitis/microbiology , Humans , Logistic Models , Male , Odds Ratio , Periodontal Pocket/classification , Periodontal Pocket/microbiology , Periodontitis/microbiology , Risk Factors , Statistics, Nonparametric , Streptococcal Infections/diagnosis , Streptococcus/classificationABSTRACT
Previous investigations have reported increased plaque formation in the presence of gingival inflammation as compared with gingival health. In these investigations, experimental gingivitis has been induced by total abolition of oral hygiene such that increased levels of salivary bacteria could contribute to the increased plaque formation. In the present study, experimental gingivitis was localized to 2 selected teeth whilst maintaining normal oral hygiene measures in the rest of the mouth. The aim of this study was to investigate whether the mass of plaque accumulating in a 3-day period is influenced by the inflammatory status of the adjacent gingival margins. Following scaling, prophylaxis and a period of optimal hygiene to establish gingival health, "plaque-guards" were worn during routine oral hygiene performance to prevent any cleaning on the buccal surfaces of teeth 14 and 15 from days 0 to 3. On day 3, accumulated plaque was removed from a 1.5 mm zone on the buccal surfaces of 14 and 15 adjacent to the gingival margins and weighed immediately. Subjects continued to wear their plaque-guards during oral hygiene until day 14 to induce experimental gingivitis around the experimental teeth. At day 14, all plaque was cleaned from the buccal surfaces of the experimental teeth and the mass of plaque accumulating over the next 3 days weighed on day 17. Comparison of plaque weights showed that the wet-weight of 3 day-old plaque was higher in the presence of experimental gingivitis than in the presence of gingival health (p = 0.02). This observation suggests that the inflammatory status of the marginal gingiva has an important effect on early, supragingival plaque accumulation.
Subject(s)
Dental Plaque/etiology , Gingivitis/complications , Adult , Bacterial Physiological Phenomena , Dental Plaque/microbiology , Dental Plaque/pathology , Dental Prophylaxis , Dental Scaling , Ecology , Female , Gingival Hemorrhage/etiology , Gingival Hemorrhage/pathology , Gingivitis/pathology , Humans , Male , Oral Hygiene , Saliva/microbiologySubject(s)
Dental Amalgam , Dental Restoration, Permanent , Periodontium/anatomy & histology , Adult , Alveolar Process/diagnostic imaging , Dental Plaque/etiology , Dental Plaque/therapy , Dental Prophylaxis , Dental Restoration, Permanent/adverse effects , Female , Gingiva/anatomy & histology , Gingivitis/therapy , Humans , Male , Oral Hygiene Index , Periodontitis/therapy , Radiography , Surface PropertiesABSTRACT
Periodontally involved multirooted teeth constitute a particular problem in periodontal therapy because of the difficulty of eliminating pocketting and producing a post-operative result which allows effective plaque control to be exercised within the involved furcation area. Various methods of treating involved furcations are described together with thier limitations.
