Sonbol, Hawazen; (2005) Prevalence and intensity of bacteraemia following conservative dento-gingival manipulative procedures in children. Doctoral thesis , UCL (University College London).

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Abstract

The prevalence, intensity and identity of bacteraemia following conservative dento-gingival manipulative procedures in children were investigated. These procedures were placement of a rubber dam, use of the fast and slow drill, placement of a matrix band and wedge and placement of a gingival retraction cord. Patients and Methods: Two hundred and five children and adolescents undergoing anaesthesia for dental treatment at the Eastman Dental Hospital were recruited. Forty-one subjects were randomly allocated to one of the five procedure groups. Following induction of general anaesthesia, a Y-cannula was inserted into a vein in either the left or right antecubital fossa using aseptic technique. A pre-operative (baseline) blood sample was taken before any dental treatment was carried out. A second blood sample (post-procedure) was taken 30 seconds following the single allocated dento-gingival manipulative procedure. All blood samples were processed using lysis filtration. Bacterial isolates were identified using both molecular and biochemical techniques. These were 16S ribosomal ribonucleic acid (rRNA) and superoxide dismutase A (sodA) partial gene sequencing in addition to carbohydrate fermentation and enzyme hydrolysis and API. Final species identification of streptococci and staphylococci was by sodA gene sequencing. The E test was used for antibiotic sensitivity testing. Results: There was a significantly greater prevalence of bacteraemia compared to baseline following placement of rubber dam (p = 0.01), placement of matrix band and wedge (p = 0.001) and placement of gingival retraction cord (p = 0.007). A significantly greater intensity of bacteraemia compared to baseline was also found following placement of rubber dam (p = 0.0001), placement of matrix band and wedge (p = 0.0001) and placement of gingival retraction cord (p = 0.001). The most frequently isolated bacteria following the dento-gingival manipulative procedures were oral streptococci (51%) and coagulase-negative staphylococci (CNS) (17%). Antibiotic sensitivity testing of oral streptococci revealed high levels of resistance to the macrolides and cephalexin. CNS showed high levels of resistance to penicillin, amoxicillin and the macrolides. Conclusions: A significantly greater prevalence and intensity of bacteraemia compared to baseline was demonstrated following rubber dam, matrix band and wedge and gingival retraction cord placement. There was a high level of resistance of oral streptococci and CNS to some of the antibiotics recommended by the national bodies for the prophylaxis of infective endocarditis.

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