An analysis of bacteremias during dental extractions - A double-blind, placebo-controlled study of chlorhexidine

Background: The literature is unclear concerning the nature and incidence of bacteremias from oral surgical procedures, the relationship of these bacteremias to dental disease, and the preventive benefit of antibacterial mouth rinses. Objective: To determine the incidence and nature of bacteremias during single-tooth extractions in adults. Methods: A double-blind, randomized placebo-controlled study of 70 patients in which the status of dental disease was compared with the incidence and nature of aerobic and anaerobic bacteremias following a single-tooth extraction and the antibacterial effect of rinses with chlorhexidine hydrochloride. Multiple indicators of dental disease were evaluated and recorded before the surgical procedure. Timing of the mouth rinses,the steps in the surgical procedure, and the two blood drawings were controlled for. Results: Thirty-one (94%) of 34 control patients and 62 (89%) of 70 patients overall had blood cultures positive for organisms at either the 1-minute and/or 3-minute mark following the initiation of surgery. The majority of cultures yielded gram-positive cocci. Cultures yielded poly-microbial organisms in 17 patients (24%). Although there was a wide range of severity of odontogenic disease, this did not correlate with results of blood cultures; However, there was a statistically significant difference in the incidence of blood cultures positive for organisms at both shorter (<3 minutes, P=.04) and longer (>6 minutes, P=.04) surgery times. There was no statistically significant difference in either the incidence of blood cultures positive for organisms or in the nature of organisms identified between the chlorhexidine and placebo groups. Conclusions: Single-tooth extraction should be expected to cause a bacteremia regardless of the status of the dentition or periodontium. Mouth rinses with chlorhexidine did not significantly alter the number of positive blood cultures or the nature of the organisms at either of the two blood drawings.