Associations between bacteremia from oral sources and distant-site infections: tooth brushing versus single tooth extraction.

OBJECTIVES: To determine the impact of antibiotic prophylaxis (AP) on the incidence of bacteremia caused by oral bacterial species associated with infective endocarditis (IE) and prosthetic joint infections (PJIs) and to compare the incidence of following tooth brushing versus single tooth extraction. STUDY DESIGN: Bacterial species in blood following single tooth extraction, with or without AP, and tooth brushing(1) were compared with IE- and PJI-associated bacteria reported in the literature. RESULTS: Of the 98 bacterial species identified in blood following single tooth extraction and tooth brushing, 32(1) and 12 were species were associated with IE and PJI, respectively. AP decreased the frequency of IE- and PJI-causing oral bacterial species in blood; however, single tooth extraction versus brushing resulted in bacteremia with IE- and PJI-causing species with similar frequencies: 65% versus 56% for IE, and 31% versus 28% for PJI. CONCLUSIONS: Although AP significantly decreased the incidence of bacteremia, the similarity between the incidence of bacteremia following brushing and extraction undermines AP as an effective strategy for the prevention of these distant-site infections.