Authors: Baumgartner JC, Heggers JP, Harrison JW.
Title: The incidence of bacteremias related to endodontic procedures. I. Nonsurgical endodontics.
Journal: J Endod
Date: May 1976
Citation: 2(5):135-40
Category: Endodontic Microbiology
Evidence-based Ranking: 4
Purpose/Objectives: To determine the incidence and to quantitative the amount of the bactermias produced by various endodontic manipulations as used in modern endodontic therapy.

Materials & Methods: Blood samples were collected from the 30 patients who underwent endodontic treatment. These patients were grouped as follows; 1. Instrumentation short of the apex- vital, 2. Instrumentation beyond the apex in pulpless teeth, 3. Instrumentation short of the apex in pulpless teeth, 4. Obturation of teeth that had vital pulps at first appointment, and 5. Obturation of teeth that had necrotic pulps at the first appointment. All instrumentation was done K-type reamers, files, and Hedstrom files. Irrigation consisted of 5.25% NaOCl, and 3% H2O2. Obturation was completed with lateral compaction and Procol-Sol sealer. All treatment was done under RDI, and paper point samples were cultured and stained to compare to any bacteria found in a blood sample. Two 20ml blood samples were taken; one before treatment and one five minutes after the most traumatic endodontic event. Samples were placed in tryptic soy broth under aerobic incubation, and brain heart infusion for anaerobic incubation. The cultures were examined at 24h, 72h, 7d, and 14d.

Results: The pulp cavities had positive cultures 20/30 times, with the main microorganism being S. faecalis. All samples before treatment were negative. 1/30 was positive after endodontic manipulation. The concentration was 3x10^3. These were found after instrumentation beyond the apex of a pulpless tooth. Bifidobacerium adolescentis was the microorganism isolated from both the blood and the pulp cavity.

AuthorÂ’s Conclusion: When confined within the root canal system, extirpation of the vital pulp before instrumentation, debridement and instrumentation of pulpless teeth, and obturation procedures in vital and nonvital do not produce bacteremias. Instrumentation beyond the apex, however, may cause bacteremia.

ReviewerÂ’s Comments: Good in vivo study that seems in be the basis for the AHA guidelines to antibiotic coverage.