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Toothbrushing May Pose Greater Risk of Endocarditis

Risk from toothbrushing may be higher than risk from single-tooth extraction because of frequency

WEDNESDAY, June 11 (HealthDay News) -- Because it is done so frequently, routine toothbrushing may pose a greater cumulative threat to people at risk of infective endocarditis than single-tooth dental extractions, undertaken with or without prophylactic amoxicillin, according to research published online June 9 in Circulation: Journal of the American Heart Association.

Peter B. Lockhart, DDS, of Carolinas Medical Center in Charlotte, N.C., and colleagues conducted a double-blind, placebo-controlled study of 290 subjects randomized among three groups: toothbrushing, single-tooth extraction with amoxicillin prophylaxis, or single-tooth extraction with placebo. Each subject had blood drawn six times to determine the presence of bacterial species known to cause infective endocarditis.

The investigators found that the overall incidence of endocarditis-causing bacteremia among the toothbrushing group, the extraction-amoxicillin group and the extraction-placebo group was 32 percent, 56 percent and 80 percent, respectively. Amoxicillin led to a significant decrease in positive cultures, they note. Toothbrushing, however, may be a greater threat than dental procedures to people susceptible to infective endocarditis because of its frequency, the researchers suggest. Bacteremia lasted for less than 20 minutes in most subjects, but the toothbrushing group had a larger percentage of positives at 60 minutes.

"The incidence, duration, nature, magnitude and daily occurrence of bacteremia from toothbrushing and other routine daily events (e.g., chewing food) calls into question the appropriateness and emphasis on prophylaxis for periodic dental procedures," the authors write. "Given the unfeasible concept of advocating antibiotic coverage for toothbrushing, we suggest that a controlled clinical trial is indicated to resolve this long-standing issue."

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