General anesthesia increases the risk of bacteremia following dental extractions.

OBJECTIVE: The influence of oral health status, the number of teeth extracted, and the anesthetic modality used is currently a matter of debate in the prevalence of bacteremia following dental extractions (BDE). The aim of the present study was to analyze the factors affecting the prevalence, duration, and etiology of BDE. STUDY DESIGN: Blood samples were collected from 210 patients at baseline, 30 seconds, 15 minutes, and 1 hour after performing dental extractions. Samples were processed in the Bactec 9240 and the subculture and further identification of the isolates were performed using conventional microbiological techniques. RESULTS: The prevalence of BDE at 30 seconds, 15 minutes, and 1 hour were 71%, 45%, and 12%, respectively. In the multivariate analysis, the "anesthetic modality" (local anesthesia versus general anesthesia) was the only variable related to BDE. CONCLUSION: General anesthesia represents a risk factor for BDE, increasing its prevalence and duration.

Oral health status of patients with a mild decrease in glomerular filtration rate.

OBJECTIVE: The aim of this study was to evaluate the oral health status of patients with mildly decreased glomerular filtration rate (GFR). STUDY DESIGN: The study group comprised 80 adults with GFR 60-89 mL/min. A group of 80 age- and gender-matched control subjects with GFR > or =90 mL/min were selected. Medical history, clinical examination, and biochemistry blood tests were performed in patients and control subjects. Renal function was estimated using the Modification of Diet in Renal Disease formula. A single dentist performed an intraoral examination of each patient and control subject. RESULTS: No significant differences were detected between patients and controls in the number of decayed, missing, or filled teeth, supragingival plaque accumulation, calculus deposits, gingival inflammation, depth of periodontal pockets, clinical attachment loss, or dental mobility. CONCLUSION: To our knowledge, this is the first study on dental health in the early stages of chronic renal failure. The results suggest that in patients with mildly decreased GFR, there are no alterations of the oral health status.

An update on the controversies in bacterial endocarditis of oral origin.

OBJECTIVES: The aim of this review was to evaluate the evidence implicating dental procedures in bacterial endocarditis (BE) development and the basis for antimicrobial prophylaxis (AP). STUDY DESIGN: In this article, the literature is reviewed and meaningful findings about epidemiology, pathogenesis, and AP guidelines for BE of oral origin are highlighted. Available results are used to formulate clinical recommendations for the dental practitioner. RESULTS: The nature of dental procedures that cause bacteremia, patients at risk for BE, and the effectiveness of AP guidelines, continue to be points of controversy. There appears to be further evidence to support the important role of oral health status in the prevention of BE of dental origin. CONCLUSIONS: One objective of the dental practitioner in caring for patients at risk for BE should be to promote oral health care. There are no hard data on which to scientifically base the need for AP in patients at risk for BE. However, it would appear prudent, at least from the medicolegal perspective, to provide AP, at least to persons with previous BE or prosthetic heart valves and to those undergoing oral surgery, periodontal treatment, or implant placement.