Bacteraemia following local anaesthetic injections in children

Objectives: To estimate odontogenic bacteraemia following three different types of local anaesthetic injections, namely: buccal infiltration analgesia (BIA), conventional intraligamental analgesia (CIA), and modified intraligamental analgesia (MIA). Patients and methods: The bacteraemia-producing potential of three methods of injecting local analgesic solution was determined by taking blood samples, using aseptic technique, from 143 children, aged 1 year 11 months to 19 years 4 months, undergoing general anaesthesia for dental extractions. Of these 143 children, a subgroup of 50 had blood taken before any dentogingival manipulative procedures to provide a baseline level of bacteraemia. The injection methods were buccal infiltration, conventional intraligamental, and a modified intraligamental. The blood samples were taken 30 seconds after injection and cultured in aerobic and anaerobic broth cultures (Bactec) and from lysis filtration vials (Isolator). Results: The percentage prevalence of bacteraemia was: baseline level 8%; buccal infiltration analgesia 16%; modified intraligamental analgesia 50%; and conventional intraligamental analgesia 97%. These values were statistically significantly different using the chi-squared test (P < 0.001). The mean value for colony forming units per millilitre (Isolator system) was 252 (sd = 646) for the intraligamental technique but zero for baseline, infiltration and modified intraligamental techniques. Conclusions: All local anaesthetic techniques studied were associated with bacteraemia which may have implications for antibiotic prophylaxis for dental treatment. The intraligamental techniques had statistically significantly greater percentage prevalence of bacteraemia compared with baseline. The modified intraligamental technique causes significantly less bacteraemia than the conventional intraligamental technique