Toothbrushing and transient bacteremia in patients undergoing orthodontic treatment

A study was made to determine the extent of bacteremia experienced by patients undergoing orthodontic treatment with fixed appliances during periods of routine oral hygiene--namely, brushing the teeth. Sixteen orthodontic patients made up the population--11 who practiced good oral hygiene and five who demonstrated poor oral hygiene. Blood was drawn aseptically from the median cubital vein of the subjects before and 15 minutes after brushing the teeth. An aliquot of each blood specimen was added to separate blood culture bottles and incubated at 37 degrees C for a period of up to 5 days. Blood was also used to determine the immune status of the subjects. Anaerobic bacteria were recovered from the blood of nine of the 16 patients studied; aerobic bacteria were not recovered. A negative blood culture before brushing and positive blood culture after brushing were expected but did not occur. Some subjects showed bacteremia before brushing and a negative blood culture after brushing. Others showed bacteremia before and after brushing. The unexpected results could be attributed to the patients eating and/or brushing before starting the test. The study showed the capacity of specific anaerobic bacteria to remain in the bloodstream for a 15-minute period. It also demonstrated a presence of bacteria in the bloodstream before the test began.