New evidence on bacteraemia

Investigation of bacteremia after debonding procedures

OBJECTIVE

The purpose of this study is to investigate the effect of debonding procedures after completion of orthodontic treatments on bacteremia.

MATERIALS AND METHODS

Twenty-eight patients who were treated with fixed orthodontic treatment at the Faculty of Dentistry's Department of Orthodontics at Gaziantep University and who had an indication of debonding were selected for this study, and blood samples were taken from these patients at different times and examined for bacteremia. Blood culture samples were taken from the antecubital veins of the patients prior to debonding (T₀), immediately after removing the bracket (T₁), and immediately after cleaning the composite residues and plaque deposits on the enamel surface (T₂). The blood samples were then inoculated in blood culture bottles and investigated for bacterial growth.

RESULTS

The results showed that there was no bacterial growth in the blood samples taken at T₀ and T₁, whereas 10 of the blood culture samples taken at T₂ showed bacterial growth including the following bacteria; Streptococcus viridans, Streptococcus mitis, Streptococcus parasanguinis, Streptococcus salivarius, Streptococcus oralis, Staphylococcus aureus, Actinomyces oris, Actinomyces naeslundii and Klebsiella pneumoniae.

CONCLUSION

It was concluded that patients in the risk group could develop bacteremia during debonding procedures. The presence of these bacteria in sterile blood suggested the possibility of bacterial endocarditis.

Review of antibiotics and indications for prophylaxis

Antibiotic prophylaxis to prevent infective endocarditis has been controversial through the years, with various changes made to recommendations provided to treating physicians and dentists. The dentist must always use his or her best judgment when applying any guideline. However, it is important to remember that the guidelines may be cited in any malpractice litigation as evidence of the standard of care. Early diagnosis with prompt treatment with effective antimicrobial therapy is the best way to lower the mortality and morbidity. When prescribing antibiotics, the clinician must realize that the overprescription of antibiotics has led to resistance to antibiotic regimens and the rise of antibiotic-resistant bacteria.