The Incidence of Bacteremia in Endodontic Manipulation: Preliminary Report†

Endodontic procedures have been under criticism by certain members of the profession for a long time, particularly as related to focal infection. Many still believe that pulpless teeth, especially those with an area of rarefaction, are a focus of infection which ultimately could produce a focal infection. The elimination of this possible focus of infection by conservative endodontic methods has been and still is questioned. Exodontic procedures, on the other hand, have never been censored. It is believed that removal of the tooth eradicates the focus and thereby eliminates the complication of a metastatic or focal infection. We should like to offer evidence that proper endodontic procedures can produce less likelihood of focal infection than exodontic procedures. It has been demonstrated clinically and experimentally that focal infection can develop as a result of a bacteremia (1) following extraction of teeth. The incidence of bacteremia as a result of exodontic and periodontal manipulation has been reported by numerous investigators (2–7). In the extraction of teeth, it has been shown that heavy trauma invariably produces a greater dispersal of microorganisms into the blood stream from the original focus. Therefore, the reduction of trauma can curtail the number of bacteria that enter the blood stream and thus prevent the complication of the development of certain organic diseases, particularly the dread subacute bacterial endocarditis in patients who have a history of rheumatic heart disease. Investigations of the relationship of endodontic procedures to bacteremia are very meager. Robinson and his group (5) did not detect the presence of bacteria in the blood in seven cases following reaming procedures and filling of the root canals. They did not state how many of each were done and whether or not cultures were taken of the root canals to determine the presence of microorganisms. In all instances they used the rubber dam. While many laboratory procedures were discussed, specific procedures for this series of cases were not given. Beechen and his group (8) found no evidence of positive blood cultures in pulpotomy procedures in one permanent molar and twenty-two deciduous molars. Their patients ranged in age from 4 to 11 years. The coronal portion of the pulp was cultured, and the organisms were identified in each case. They were able to obtain a 10 ml. sample of blood in their young patients. Ross and Rogers (9) treated six cases and found that in three cases of vital extirpation blood cultures were all positive, while in three cases of necrosis of the pulp they were all negative. They explain that the positive blood cultures were due to the organisms being carried into the blood stream through the pulpal circulation by means of the broaches and reamers as they traversed the infected portion of the carious process in the coronal portion of the pulp. The three cases of necrosis of the pulp produced negative cultures because there was no pulpal circulation to propel the bacteria into the blood stream. They did not take cultures of the coronal portion or root canals of the teeth tested. The following study was done to determine whether or not endodontic procedures can produce a bacteremia. If no bacteremias or a smaller incidence of bacteremias occur following endodontic procedures as compared to exodontic procedures, endodontics may be the treatment of choice, particularly for patients with valvular heart disease.