Poor oral hygiene as a risk factor for infective endocarditis-related bacteremia

Peter B. Lockhart, Michael T. Brennan, Martin Thornhill, Bryan S. Michalowicz, Jenene Noll, Farah K. Bahrani-Mougeot, Howell C. Sasser

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319 Scopus citations


Background. Infective endocarditis (IE) often is caused by bacteria that colonize teeth. The authors conducted a study to determine if poor oral hygiene or dental disease are risk factors for developing bacteremia after toothbrushing or single-tooth extraction. Methods. One hundred ninety-four participants in a study were in either a toothbrushing group or a single-tooth extraction with placebo group. The authors assessed the participants' oral hygiene, gingivitis and periodontitis statuses. They assayed blood samples obtained before, during and after the toothbrushing or extraction interventions for IEassociated bacteria. Results. The authors found that oral hygiene and gingival disease indexes were associated significantly with IE-related bacteremia after toothbrushing. Participants with mean plaque and calculus scores of 2 or greater were at a 3.78and 4.43-fold increased risk of developing bacteremia, respectively. The presence of generalized bleeding after toothbrushing was associated with an almost eightfold increase in risk of developing bacteremia. There was no significant association between any of the measures of periodontal disease and the incidence of bacteremia after toothbrushing. The oral hygiene or disease status of a tooth was not significantly associated with bacteremia after its extraction. Conclusion. Bacteremia after toothbrushing is associated with poor oral hygiene and gingival bleeding after toothbrushing. Clinical Implications. Improvements in oral hygiene may reduce the risk of developing IE.

Original languageEnglish (US)
Pages (from-to)1238-1244
Number of pages7
JournalJournal of the American Dental Association
Issue number10
StatePublished - Oct 2009

Bibliographical note

Funding Information:
This study was funded by the National Institute of Dental and Craniofacial Research, National Institutes of Health grant R01 DE13559-01, and a grant from the Health Services Foundation of the Carolinas Medical Center, Charlotte, N.C.


  • Bacteremia
  • Bacteria
  • Heart valves
  • Infective endocarditis
  • Risk factors


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