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Medical Forum / General / Dentistry / November 2007

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bacteremia level testing?

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Robert - 15 Nov 2007 13:54 GMT
I have read several articles about bacteria levels in the bloodstream from
periodontal disease, as well as after various oral procedures, such as RCT
and extraction. (I think it is referred to as "bacteremia".) I know many
here have talked about this as well.

However, how does one get tested for the bacteremia level in the blood?  Can
you go to a doctor and ask him to test your bacteremia level?

Thanks.
George - 16 Nov 2007 18:38 GMT
> I have read several articles about bacteria levels in the bloodstream from
> periodontal disease, as well as after various oral procedures, such as RCT
[quoted text clipped - 5 lines]
>
> Thanks.

The bacteremia caused by dental procedures is transient in nature. I
don't know if there is a test to measure the bacterial load in
circulation (there might well be), but it would have to be
administered straight after the procedure to be of any use. Frankly,
as there is no way to stop bacteremia from occurring after oral
surgery I don't think there's much point in getting tested!

PS brushing and flossing may also cause transient bacteremia.
Neil W - 16 Nov 2007 20:34 GMT
>> I have read several articles about bacteria levels in the bloodstream
>> from periodontal disease, as well as after various oral procedures, such
[quoted text clipped - 14 lines]
>
> PS brushing and flossing may also cause transient bacteremia.

Thanks. The reason I am asking is that many people here maintain that RCT
causes constant, low-level bacteremia. I have not had RCT but there is a
possibility I might need it. If I do, I want to know if there is a way of
monitoring the bacteremia.  How do they do it in the studies?
Steven Bornfeld - 17 Nov 2007 03:19 GMT
>>> I have read several articles about bacteria levels in the bloodstream
>>> from periodontal disease, as well as after various oral procedures, such
[quoted text clipped - 18 lines]
> possibility I might need it. If I do, I want to know if there is a way of
> monitoring the bacteremia.  How do they do it in the studies?

    Considering that bacteremia has been demonstrated from flossing,
brushing, and even just eating (in the presence of periodontal disease)
it is hard to imagine how any bacteremia can be attributed to any
specific tooth, absent a surgical procedure.  The latest recommendations
of the AHA have vastly curtailed the indications for antibiotics, and in
the UK there is a recommendation to eliminate antibiotic prophylaxis for
dental procedures altogether.  Apparently any bacteremia is not
considered a significant risk (though I would like to see the rationale
for this change).

Steve
George - 17 Nov 2007 23:42 GMT
On Nov 17, 3:19 am, Steven Bornfeld <dentaltwinm...@earthlink.net>
wrote:
> >>> I have read several articles about bacteria levels in the bloodstream
> >>> from periodontal disease, as well as after various oral procedures, such
[quoted text clipped - 30 lines]
>
> Steve

I believe the stated that ABs don't provide foolproof protection
against endocarditis. Also, it's an extremely rare disease and you're
more likely to suffer a life-threatening anaphylaxis from the ABs
rather than contracting endocarditis.

Regards,
George
Newbie@bix.nex - 18 Nov 2007 21:25 GMT
>Apparently any bacteremia is not
>considered a significant risk (though I would like to see the rationale
>for this change).
>
>Steve

As usual, your analysis is well considered.

As far as "rationale" goes,  it would be much better
to examine a few statistical analyses of complications
post dental treatment. By that I mean, that a rationale is
no reason for change, it is better to have a bit of proof
before modifying the standard.

Just my thoughts, no reason for anyone else to agree.

But of course am just being a stickler here on this specific point.

I would love to buy you an excellent Scotch Wisky drink
and share it together with Dr. SM.
Us three would have a most excellent time.
A good steak woudn't hurt either.
Steven Bornfeld - 18 Nov 2007 22:22 GMT
>> Apparently any bacteremia is not
>> considered a significant risk (though I would like to see the rationale
[quoted text clipped - 11 lines]
>
> Just my thoughts, no reason for anyone else to agree.

    Let me add that the changes in the UK have not yet been approved--but
they are recommendations by a study group whose recommendations are
generally adopted.  They are in quite some detail, but given this
(bacterial endocarditis) has been an issue in dentistry for so many
years there must be a hugh volume of data on this issue.  So when a
radical change in recommendations is proposed you have to wonder--what
happened?

Steve

> But of course am just being a stickler here on this specific point.
>
> I would love to buy you an excellent Scotch Wisky drink
>  and share it together with Dr. SM.
> Us three would have a most excellent time.
> A good steak woudn't hurt either.
Amatus Cremona - 19 Nov 2007 15:19 GMT
Let's plan it

Signature

/

Amatus

/

>
>>Apparently any bacteremia is not
[quoted text clipped - 19 lines]
> Us three would have a most excellent time.
> A good steak woudn't hurt either.
Mark & Steven Bornfeld - 19 Nov 2007 15:31 GMT
> Let's plan it

    Sounds really good.  However, I have trouble planning what I'm going to
wear for the day.

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

Amatus Cremona - 19 Nov 2007 16:12 GMT
Put on a blue polo and khaki pants.  Let's go.

Signature

/

Amatus

/

>> Let's plan it
>
> Sounds really good.  However, I have trouble planning what I'm going to
> wear for the day.
>
> Steve
George - 23 Nov 2007 22:26 GMT
> Thanks. The reason I am asking is that many people here maintain that RCT
> causes constant, low-level bacteremia. I have not had RCT but there is a
> possibility I might need it. If I do, I want to know if there is a way of
> monitoring the bacteremia.  How do they do it in the studies?

They take a blood sample before and after the dental procedure and
they culture it. It's a complex procedure though. Here's an abstract
to give you an idea.

Prevalence, duration and aetiology of bacteraemia following dental
extractions.
Tomás I, Alvarez M, Limeres J, Potel C, Medina J, Diz P.

Department of Special Needs, School of Medicine and Dentistry,
Santiago de Compostela University, Santiago de Compostela, and
Research Laboratory, Department of Clinical Microbiology, Xeral-Cíes
Hospital, Vigo, Spain.

OBJECTIVE: To investigate the prevalence, duration and aetiology of
bacteraemia following dental extractions, analysing the factors
affecting its development. SUBJECTS AND METHODS: The study group was
composed of 53 patients undergoing dental extractions under general
anaesthesia. Peripheral venous blood samples were collected at
baseline and at 30 s, 15 min and 1 h after the dental extractions.
Samples were inoculated into BACTEC PLUS aerobic and anaerobic blood
culture bottles and were processed in Bactec 9240. Subculture and
further identification of the bacteria isolated was performed by
conventional microbiological techniques. RESULTS: The prevalence of
bacteraemia following dental extractions was 96.2% at 30 s, 64.2% at
15 min and 20% at 1 h after completing the surgical procedure. The
bacteria most frequently identified in the positive blood cultures
were Streptococcus spp. (63.8%), particularly Streptococcus viridans.
CONCLUSIONS: In our series, the majority of patients undergoing dental
extractions developed bacteraemia, usually of a streptococcal nature,
independently of the grade of oral health and of the number of
extractions performed. Positive blood cultures persisted for at least
1 h after the dental procedure in a considerable number of patients,
questioning the supposedly transient nature of bacteraemia following
dental extractions.

Low-level bacteraemia following RCT would be very difficult to prove,
since the bacteraemia may well be caused by other oral factors like
oral hygiene and periodontal disease. There is no practical way of
monitoring bacteraemia, if that's what you're concerned about. Your
body is naturally adapted to cohabiting with a wide variety of
bacteria and you can help maintain strong natural defences by living
healthily.

Regards,
George
Steven Bornfeld - 17 Nov 2007 03:14 GMT
>> I have read several articles about bacteria levels in the bloodstream from
>> periodontal disease, as well as after various oral procedures, such as RCT
[quoted text clipped - 14 lines]
>
> PS brushing and flossing may also cause transient bacteremia.

    I have seen papers where oral bacteria have been cultured in cases of
endocarditis.  I don't see how you could quantify this on a systemic
basis.  Of course, considering the changing recommendations for
antibiotic prophylaxis, one wonders what exactly has changed to prompt
the change.

Steve
 
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