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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 IE-associated 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 3.78- and 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.

Biofilms are a complex community of microorganisms characterized by the excretion of an adhesive and protective extracellular matrix, microbe-to-microbe attachment, structural heterogeneity, genetic diversity, and complex community interactions. Bacteria growing in dental biofilms display an increased tolerance to antibiotics and antimicrobial agents, including those used in dentifrices and mouthrinses. The microbial challenge associated with the inflammatory periodontal diseases induces an immediate inflammatory and immune response in the host. The nature and magnitude of the response has an impact on the severity and rate of progression of the periodontal disease. It is this host inflammatory-immune response that ultimately leads to the clinical signs and symptoms of gingivitis and chronic periodontitis. The traditional treatment modality of scaling and root planing (SRP) remains the "gold standard" for the non-surgical management of chronic periodontitis. Even clinically successful treatment has a high probability of pocket reinfection. Re-infection of periodontal pockets results from residual biofilms, increased tolerance of microbes within a dense, mature biofilm to antibiotics, reservoirs of bacteria in calculus, and reservoirs of bacteria within the dentinal tubules of infected root surfaces. Thus, for maximum effect, a combination of scaling and root planing and locally delivered antimicrobials should be considered if non-surgical therapy is the treatment of choice.

Objectives: We investigated the relationship between Helicobacter pylori infection and abnormal periodontal conditions., Methods: Data from the first phase of the third National Health and Nutrition Examination Survey were used. A total of 4504 participants aged 20 to 59 years who completed a periodontal examination and tested positive for H. pylori antibodies were examined., Results: Periodontal pockets with a depth of 5 mm or more were associated with increased odds of H. pylori seropositivity (odds ratio [OR] = 1.47; 95% confidence interval [CI] = 1.12, 1.94) after adjustment for sociodemographic factors. This association is comparable to the independent effects of poverty on H. pylori (OR = 1.54; 95% CI = 1.10, 2.16)., Conclusions: Poor periodontal health, characterized by advanced periodontal pockets, may be associated with H. pylori infection in adults, independent of poverty status.

Does reduction of supragingival calculus provide only a cosmetic effect, or does it benefit oral health as well? The author discusses the causes and effects of calculus development and reviews methods of calculus control.

Objective: To investigate a reported association between dental disease and risk of coronary heart disease., Setting: National sample of American adults who participated in a health examination survey in the early 1970s., Design: Prospective cohort study in which participants underwent a standard dental examination at baseline and were followed up to 1987. Proportional hazards analysis was used to estimate relative risks adjusted for several covariates., Main Outcome Measures: Incidence of mortality or admission to hospital because of coronary heart disease; total mortality., Results: Among all 9760 subjects included in the analysis those with periodontitis had a 25% increased risk of coronary heart disease relative to those with minimal periodontal disease. Poor oral hygiene, determined by the extent of dental debris and calculus, was also associated with an increased incidence of coronary heart disease. In men younger than 50 years at baseline periodontal disease was a stronger risk factor for coronary heart disease; men with periodontitis had a relative risk of 1.72. Both periodontal disease and poor oral hygiene showed stronger associations with total mortality than with coronary heart disease., Conclusion: Dental disease is associated with an increased risk of coronary heart disease, particularly in young men. Whether this is a causal association is unclear. Dental health may be a more general indicator of personal hygiene and possibly health care practices.