Bacteremia From Dental Procedures Dental procedures are a frequent source of bacteremia, par- ticularly from VGS.40 48 Multiple clinical studies of chil- dren over the past 40 years focused on the impact of 1 of the following risks for development of bacteremia: class of prophylactic antibiotic drug49 ; nature and invasiveness of ; indices of oral hygiene and dis- ; timing of blood culture draws before, dur- ing, and after the dental procedure45,48,56 ; various methods of microbial analysis and identification44,57 ; and the impact of these variables on surrogate measures of risk for IE, such as the incidence, duration, nature, and magnitude of bactere- Clearly, these surrogate measures are also influenced by multiple host factors. These variable risks are associated with a wide range (0% 97%) in the incidence of bacteremia in children after various dental procedures and other manipulations of the gingiva, for example, tooth extractions (0% 96%)41,44,45,48 50,53,57 60 ; teeth cleaning and electric toothbrushing (0% 78%)42,45,47,55,61 63 ; res- ; dental injections (16% 97%)52,64 ; and other manipulations (13% 44%).42,44,46,51 53 Of the more than 100 oral bacterial species recovered from blood cultures in children after dental procedures, the number and variety of species reflect the spectrum of oral flora in health and disease (Table 2). They also reflect the varied microbiological meth- odologies used in these studies (eg, culture-based rather than molecular), with the recognition that many bacterial species clearly enter the bloodstream but are not cultivable and there- fore not recorded.44,49,57 Of greatest importance is the subset of bacterial species reported in blood cultures after dental proce- dures that are known to cause IE.66 Finally, the varied method- ologies and results make it impossible to differentiate among procedures with regard to their risk for causing bacteremia. 