Relationship between odontogenic bacteremia and orthodontic stripping

Orthodontics in patients with significant medical co-morbidities

A wide variety of patients with medical co-morbidities may present to general orthodontic practice. It is important for the treating clinician to have a general understanding of key medical conditions that may impact upon the treatment and management options. This clinical supplement provides a treatment-focused summative update for the orthodontist regarding significant medical co-morbidities, their general prevalence and an exploration of potential impacts upon orthodontic treatment. This review also discusses the significance of key medications and provides suggestions for the safe provision of orthodontic treatment.

A case report of pyopneumopericardium following bungee jumping in a patient with tuberculosis

RATIONALE

Pyopneumopericardium related to bungee jumping is a rare occurrence in the current antibiotic era. We present a case of esophagus-seeded Streptococcus sanguinis pyopneumopericardium in a young man with tuberculosis who had just completed bungee jumping.

PATIENT CONCERN

A 27-year-old man was hospitalized with a 1-day history of fever, chest tightness, and intermittent sharp chest pain after bungee jumping for the first time.

DIAGNOSES

Clinical examinations, thoracentesis, and pericardiocentesis revealed pyopneumopericardium, pyopneumomediastinum, and suppurative pleurisy secondary to bungee-jumping-related traumas. Pericardial fluid cultures were positive for S sanguinis, and Mycobacterium tuberculosis complex genetic test was positive in both sputum and pleural effusion.

INTERVENTIONS

The patient improved with drainage and comprehensive antimicrobial therapy.

OUTCOMES

The patient developed constrictive pericarditis and underwent pericardiectomy after 6 months of anti-tuberculosis treatment. During the 6-month follow-up after surgery, he recovered uneventfully.

LESSONS

This case adds to the long list of bungee-jumping complications. Early diagnosis to initiate appropriate therapy is critical for pyopneumopericardium patients to achieve good outcomes.

Bacteremia after micro-osteoperforation

OBJECTIVE

To find out the presence of bacteremia following micro-osteoperforation.

MATERIAL AND METHODS

The sample consisted of 28 Class I orthodontic patients (21 women, 7 men; mean age, 18.11±0.4 years). The micro-osteoperforation was performed 4 weeks following bonding of fixed orthodontic appliances. Using aseptic technique, 20-mL blood sample was collected before the micro-osteoperforation and another 20-mL, 60 seconds after the first micro-osteoperforation. The blood was inoculated into culture bottles and incubated at 37°C for 1 week. Bacterial growth was investigated by using Gram staining technique. The results were analysed using the McNemar test.

RESULT

No significant difference between the preoperative and postoperative samples was found with respect to bacteremia (P=0.229).

CONCLUSION

Micro-osteoperforation technique is not related to transitory bacteremia.

Investigation of bacteremia after debonding procedures

OBJECTIVE

The purpose of this study is to investigate the effect of debonding procedures after completion of orthodontic treatments on bacteremia.

MATERIALS AND METHODS

Twenty-eight patients who were treated with fixed orthodontic treatment at the Faculty of Dentistry's Department of Orthodontics at Gaziantep University and who had an indication of debonding were selected for this study, and blood samples were taken from these patients at different times and examined for bacteremia. Blood culture samples were taken from the antecubital veins of the patients prior to debonding (T₀), immediately after removing the bracket (T₁), and immediately after cleaning the composite residues and plaque deposits on the enamel surface (T₂). The blood samples were then inoculated in blood culture bottles and investigated for bacterial growth.

RESULTS

The results showed that there was no bacterial growth in the blood samples taken at T₀ and T₁, whereas 10 of the blood culture samples taken at T₂ showed bacterial growth including the following bacteria; Streptococcus viridans, Streptococcus mitis, Streptococcus parasanguinis, Streptococcus salivarius, Streptococcus oralis, Staphylococcus aureus, Actinomyces oris, Actinomyces naeslundii and Klebsiella pneumoniae.

CONCLUSION

It was concluded that patients in the risk group could develop bacteremia during debonding procedures. The presence of these bacteria in sterile blood suggested the possibility of bacterial endocarditis.

Prevalence and intensity of bacteraemia following orthodontic procedures

BACKGROUND

There is a possibility that bacteria may enter the blood stream during some non-surgical manipulation procedures, which include orthodontic treatment procedures (alginate impression taking, separator placement, band cementation, and archwire change).

OBJECTIVES

The aim of this study was to determine the prevalence and intensity of bacteraemia associated with orthodontic procedures in patients seen at the Lagos University Teaching Hospital, Nigeria.

METHODOLOGY

A total of 100 subjects who presented at the Orthodontic Clinic of the Lagos University Teaching Hospital and who met the inclusion criteria were recruited for the study. Four orthodontic procedures were investigated: alginate impression taking, separator placement, band cementation and archwire placement. Subjects were randomly placed in one of the four procedure groups. Peripheral blood was collected for microbiologic analysis before the orthodontic procedures and within 2 min of completion of the procedures. The BACTEC automated blood culture system and the lysis filtration method of blood culturing were used for microbiological analysis of the blood samples. The Wilcoxon signed rank test, the McNemar χ(2) test, the Mann-Whitney U-test, and Spearman and point bi-serial correlations were used for statistical evaluation at the P<0.05 level.

RESULTS

A significant increase in the prevalence and intensity of bacteraemia was observed following separator placement. The predominant bacteria isolated from the blood cultures were Streptococcus viridans and Staphylococcus species.

CONCLUSION

Separator placement induced the highest levels of bacteraemia. Use of a 0.2% chlorhexidine mouth rinse is recommended prior to separator placement in orthodontic patients.

Bacteremia after piezocision

INTRODUCTION

The aim of this study was to investigate the presence of transient bacteremia after a piezocision procedure.

METHODS

The sample consisted of 30 subjects (24 women, 6 men; mean age, 19.6 ± 0.7 years; range, 18.1-22.4 years) with the American Society of Anesthesiologists' physical status I. All patients had Class I skeletal and dental relationships and had fixed orthodontic treatment with the Damon system. The piezocision surgery was performed 1 week after the placement of the orthodontic appliances in all patients. Two 20-mL venous blood samples were collected before and 30 to 60 seconds after the first microincision using an aseptic technique. The samples were inoculated into BACTEC Plus aerobic and anaerobic blood culture bottles and were assessed in the BACTEC blood culture analyzer (Becton Dickinson Diagnostic Instrument Systems, Sparks, Md). The results were analyzed statistically using the McNemar test, with P <0.05 indicating statistical significance.

RESULTS

No significant difference between the preoperative and postoperative samples was determined with respect to transient bacteremia (P = 0.250). No bacteremia was detected in the pretreatment samples, although Gemella sanguinis, Streptococcus pluranimalium, and Streptococcus mitis/oralis were detected in 3 postoperative blood samples.

CONCLUSIONS

The piezocision procedure might be related to transitory bacteremia. Hence, orthodontists should consider the possibility of bacterial endocarditis in at-risk patients when piezocision is part of the treatment plan.