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Antibiotics Before You Brush?

So I was looking for a good health story to blog about when I came across a report from the Reuters news service -- on which I often rely and which I always have trusted -- that seemed to suggest that a new study showed toothbrushing releases potentially dangerous bacteria into the bloodstream. Here's the Reuters report's first and last paragraphs; you can read the whole thing here:

NEW YORK (Reuters Health) - Brushing one's teeth is nearly as likely as removing a tooth to temporarily cause bacteria to enter the bloodstream, according to a report in the journal Circulation. This finding is concerning because bacteria in the blood can lead to a rare, but potentially serious heart problem called infective endocarditis, the infection of the heart valves and chambers.

These findings suggest that brushing poses a risk for bacteria in the blood similar to that of a dental extraction, the authors note, and that antibiotic treatment beforehand is only partially effective in preventing this.

Antibiotic treatment before toothbrushing?

Of course I had to get my hands on a copy of that study.

When I did, I learned that its author, Peter Lockhart, chairman of the department of oral medicine at Carolinas Medical Center in Charlotte, North Carolina, had actually embarked on his study to help sort out whether it's really necessary to administer preventive antibiotics to people with certain health conditions before they have a tooth pulled. According to the study, tooth extractions have long been thought to allow bacteria -- including varieties that can harm the heart -- to enter the bloodstream.

But there's been much debate over the years about which dental patients should receive prophylactic antibiotics before having teeth yanked; the list started with people with cardiac conditions and has "mushroomed," Lockhart says, to include people with all kinds of other health conditions that put them at risk of "distant infection" in which bacteria enter the body through in one place and end up doing harm elsewhere. Lockhart is concerned about not only patients' personal health but also the overuse of antibiotics (which can make bacteria resistant to the drugs) and the cost of all those perhaps unnecessary doses of medication.

Lockhart and his colleagues measured the amount of bacteria -- especially the heart-damaging kinds -- in 290 participants' blood at several intervals after they had either had a tooth extracted after taking antibiotics, had a tooth extracted after taking a placebo, or simply brushed their teeth.

Turns out that 19 percent of patients in the toothbrushing group, 33 percent of those in the extraction/antibiotic group, and 58 percent of those in the extraction/placebo group had bacteria of the potentially heart-damaging kind in their bloodstream in the first five minutes after the procedure they'd undergone.

After an hour, 5 percent of the extraction/placebo group and 2 percent of the brushing group still had potentially disease-causing bacteria in their blood. None of the bacteria remained in the bloodstreams of those who had taken antibiotics.

Lockhart argues that, since the differences among the three groups were so minimal in the end, dental health providers might want to shift their focus away from preventing tooth-extraction-related infections with antibiotics to encouraging better dental hygiene so people don't end up having to have teeth pulled in the first place. Though he did point out that, because we brush our teeth so frequently, and because toothbrushing can disrupt more gum surface than a tooth extraction does, toothbrushing provides bacteria with easy entree to the bloodstream. But he also writes, "Given the unfeasible concept of advocating antibiotic coverage for toothbrushing, we suggest that a controlled clinical trial is indicated to resolve this longstanding issue."

That sounds like a whole different study from the one in the Reuters report. Just a reminder to take your news reports -- even those from really reliable sources -- with a grain of salt.

By Jennifer LaRue Huget  |  June 11, 2008; 7:00 AM ET
Categories:  General Health  
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