Cell lysis methods can be problematic, being time consuming, expensive, less sensitive for some oral bacte- rial species, and slower in detection, and having an increased risk of contamination. Results from different studies reflect the difficulty of determining magnitude, but the collective results suggest that the magnitude from dental procedures is low. Data from a large study of adults that used broth-based meth- ods and molecular methodology for identification suggest that the magnitude of bacteremia resulting from toothbrushing and a dental extraction, opposite ends of the spectrum of gingival invasiveness, are both relatively low at <104 colony-forming units per milliliter of blood.68 The degree to which systemic antibiotic drugs reduce the incidence, duration, nature, or magnitude of bacteremia associated with dental procedures is controversial. Large, well-designed studies suggest that amoxicillin has a highly statistically significant impact on reducing the incidence and duration of bacteremia and changes the species identified after dental procedures in children.45 It is not clear whether this antibiotic elimination of bacteria takes place in the gingi- val crevice or the bloodstream or whether it reduces the risk for IE. 