Factors affecting incidence of bacteremia due to dental extractions [Fattori che influenzano l’incidenza della batteriemia dopo estrazioni dentarie]

OBJECTIVES Bacteremia of oral origin is de-fined as the presence of bacteria, coming from the supra and sub-gingival plaque, in the blood-stream. Usually, bacteremia is transient and asymptomatic, but in some cases, it can lead to clinical sequelae, such as septic shock and distant-site infections, including infective endocarditis. Many dental procedures and toothbrushing, can lead to the dissemination of these bacteria in the bloodstream, so, over time, antibiotic prophylaxis protocols have been set for patients at risk who are about to undergo to invasive dental procedures (e.g. dental extractions, scaling and root planing). However, the role of patient’s clin-ical history and clinical picture in influencing the bacteremia asso-ciated with these dental proce-dures is still controversial. The aim of this review is to ana-lyze all those factors that, accord-ing to the literature, could be relat-ed with the incidence of bactere-mia after tooth extractions, in pa-tients at high risk of infective endocarditis. MATERIALS AND METHODS We performed a research in Pubmed, Embase and Google Scholar, including all clinical randomized trials aimed at analyzing the incidence of bacteremia after extractions through the analysis of blood samples. RESULTS AND CONCLUSIONS In patients at high risk of infective endocarditis, antibiotic prophylaxis using amoxicillin can produce a significant reduction on the inci-dence of bacteremia after tooth extractions. Second-choice antibi-otics in prophylaxis, such as clin-damycin or azitromycin, lead to lower reduction in bacteremia, as well as being associated with a greater number of adverse reac-tions. Also chlorhexidine mouth-wash is less effective than amoxi-cillin, however, since it’s cheap and is characterized by a total absence of adverse reactions, routine use is recommended before dental extractions. No strong correlation between the incidence of bacteremia and the patient’s age or sex, the number of teeth to extracted, the invasiveness of the procedure and the periodontal health indices could be found. However, further randomized clinical trials are required to show a conclusive dissertations; in particular, studies that analyze the prevalence of infective endocarditis as primary clinical outcome, and studies that identify the number of bacteria in the bloodstream are needed, since most of literature currently focuses only on the inci-dence of bacteremia (presence/ absence of bacteria in the blood). The uses of antibiotic prophylax-is before tooth extractions in pa-tients at risk has been largely debated, over the last few years. However, amoxicillin was found to significantly reduce the incidence of bacteremia due to dental extractions, in high risk patients. CLINICAL SIGNIFICANCE This review analyzes all those factors that could be related to the incidence of bacteremia after dental extractions, providing to the clinician useful information to assess the bacteremic risk incurred by any patient who is about to undergo that procedure.