Daly C G, Mitchell D H, Highfield J E, Grossberg D E, Stewart D
Discipline of Periodontics, University of Sydney, Australia.
J Periodontol. 2001 Feb;72(2):210-4. doi: 10.1902/jop.2001.72.2.210.
Infective endocarditis can occur in susceptible individuals due to bacteremia of oral origin. The aim of this study was to investigate the occurrence of bacteremia caused by full mouth periodontal probing.
Forty patients, 20 with adult periodontitis (10 males, 10 females; mean age 43.0 years) and 20 with chronic gingivitis (11 males, 9 females; mean age 35.5 years) were investigated. Prior to and immediately following periodontal probing, 20 mL of venous blood were obtained from each patient and inoculated into aerobic and anaerobic blood culture bottles and incubated. Negative bottles were monitored continuously for 3 weeks before being discarded. Bottles which signalled positive were subcultured and isolates identified to genus level. Periodontal probing consisted of measuring pockets at 6 points around each tooth and recording the presence or absence of bleeding. A plaque index (PI) was assessed on the 6 Ramfjord teeth.
Probing caused bacteremia of oral origin in 8 (40%) of the periodontitis patients and 2 (10%) of the gingivitis patients. Streptococcus spp. were the most common isolates in both groups. Compared with the gingivitis group the odds ratio (OR) for bacteremia in the periodontitis group was 5.993 (95% CI 1.081 to 33.215). Bleeding on probing (OR 1.025, 95% CI 1.004 to 1.047) and mean probing depth per tooth (OR 1.444, 95% CI 1.055 to 1.977) were significantly associated with bacteremia. No significant correlations were found between bacteremia and age, number of teeth probed, smoking status, PI, or total probing depth.
Patients with untreated adult periodontitis are at greater risk of bacteremia due to periodontal probing than patients with chronic gingivitis. For individuals at risk of infective endocarditis, radiographic assessment prior to periodontal probing would be advisable to identify those with periodontitis so that appropriate antibiotic prophylaxis can be provided.
由于口腔源性菌血症，感染性心内膜炎可发生在易感个体中。本研究的目的是调查全口牙周探诊引起菌血症的发生率。
对40例患者进行了调查，其中20例患有成人牙周炎（男性10例，女性10例；平均年龄43.0岁），20例患有慢性牙龈炎（男性11例，女性9例；平均年龄35.5岁）。在牙周探诊前和探诊后立即从每位患者采集20 mL静脉血，接种到需氧和厌氧血培养瓶中并进行培养。阴性瓶在丢弃前连续监测3周。发出阳性信号的瓶进行传代培养，并将分离株鉴定到属水平。牙周探诊包括测量每颗牙齿周围6个点的牙周袋深度，并记录有无出血。在6颗Ramfjord牙齿上评估菌斑指数（PI）。
探诊导致8例（40%）牙周炎患者和2例（10%）牙龈炎患者发生口腔源性菌血症。链球菌属是两组中最常见的分离株。与牙龈炎组相比，牙周炎组菌血症的优势比（OR）为5.993（95%CI 1.081至33.215）。探诊出血（OR 1.025，95%CI 1.004至1.047）和每颗牙齿的平均探诊深度（OR 1.444，95%CI 1.055至1.977）与菌血症显著相关。菌血症与年龄、探诊牙齿数量、吸烟状况、PI或总探诊深度之间未发现显著相关性。
未经治疗的成人牙周炎患者因牙周探诊发生菌血症的风险高于慢性牙龈炎患者。对于有感染性心内膜炎风险的个体，在牙周探诊前进行影像学评估以识别牙周炎患者，以便提供适当的抗生素预防是可取的。
